Reports about lateral lumbar or thoracic interbody fusion (LLIF) using expandable interbody spacers are sparse. To report our experience with the use of expandable spacers for LLIF. We reviewed all consecutive LLIF patients with use of an expandable titanium interbody implant (ELSA® Expandable Integrated LLIF Spacer, Globus Medical Inc, PA (USA)) between September 2018 and January 2024. We identified 503 patients, in which we performed LLIF at 732 levels. In 63 patients (12.5%) and 70 levels (9.6%) an expandable spacer was used. The mean age was 61.4 years, 57.1% were females. LLIF was performed between T11/12 – L4/5 in the setting of fusion procedures (mono-/bisegmental (20; 28.6%), 3–7 segments (29; 41.4%); >7 segments (21; 30.0%)), of which 21 (33.3%), 20 (31.8%) and 22 (34.9%) were for traumatic, deformity/revision and other diagnoses. Surgery included release of the anterior longitudinal ligament in 30 cases (42.9%). Intraoperative adverse events (AEs) were noted in 2 (3.2%), postoperative AEs in 27 (42.9%) at discharge, 17 (27.0%) at 3 months and 14 (22.2%) at 12 months. Segmental sagittal Cobb angle changed from 1.3° (preoperative) to 13.0° at discharge (p < 0.001), 12.7° at 3 months (p < 0.001) and 13.3° at 12 months (p < 0.001). Functional outcome was excellent/good in 43 (68.3%; 5 missing) at 3 months and in 37 (58.7%; 10 missing) at 12 months. The use of LLIF with an expandable spacer was safe, promoted solid fusion and enabled powerful correction of sagittal segmental Cobb angle, which was maintained during follow-up.

Background/Objectives: The concept of frailty has been recognized as an important issue which can influence postoperative outcomes. We aimed to investigate the influence of frailty on clinical and radiological outcomes in patients undergoing transforaminal lumbar interbody fusion (TLIF) for degenerative spine disease. Methods: A single-center, retrospective cohort study was conducted involving 408 patients in whom 506 expandable interbody devices were implanted. The patients were grouped into vulnerable/frail versus well/fit according to the Canadian Frailty Index. Results: The frail patients were older and had a larger number of fused segments (3.0 vs. 2.4 segments, p = 0.009). In the univariate analysis, the frail patients were more likely to experience a postoperative adverse event (AE) until discharge (OR 1.89, 95% CI 1.22–2.92; p = 0.004), three (OR 1.57, 1.07–2.3; p = 0.021), and 12 months postoperatively (OR 3.77, 1.96–7.24; p < 0.001). Following the multivariable logistic regression analysis, frailty remained an independent risk factor for postoperative AEs at 12 months (OR 3.44, 95% CI 1.69–6.99; p = 0.001). Conclusions: Frailty negatively influenced the rate of AEs until 12 months, while the odds of having a favorable outcome at any time remained unaffected in patients undergoing posterior spinal fusion with TLIF. Future efforts are needed to evaluate whether preoperative medical optimization or prehabilitation may positively impact patient outcomes.

Subsidence of transforaminal lumbar interbody fusion (TLIF) cages is a common complication. Little is known about risk factors for cage subsidence (CS) of expandable spacers. To develop a score for CS risk stratification. We reviewed consecutive patients treated by TLIF with a specific type of expandable interbody implant. CS at the 3-month follow-up was defined as primary endpoint. We identified risk factors, calculated their effect sizes using multivariable logistic regression models and developed the Expandable TLIF Subsidence Index (ETSI). Area Under the Receiver Operating Curve (AUROC) was performed. We identified n = 388 patients (mean age 64.8 years, 55.9 % female), in which we performed TLIF at 482 levels. CS at 3 months was evident in n = 123 patients and on 153 levels (31.7 %). Independent risk factors for CS were high ASA score (3&4; odds ratio (OR) 2.19, 95 % confidence interval (CI) 1.37–3.50, p = 0.008), indication for surgery other than degenerative or deformity (4.79, 1.75–13.1, p = 0.002), lower lumbar spine (L3/4-L5/S1; 4.31, 1.46–12.7, p = 0.008), small cage size (1.94, 1.22–3.07, p = 0.005), and more posterior position of the cage in the intervertebral space (1.68, 1.15–2.43, p = 0.007). The ETSI with a range from -2-6 points obtained an AUROC of 0.6807, indicating a moderate classification result. For each 1-step increase in the ETSI, an OR of 2.02 (1.63–2.50, p < 0.001) to develop CS was calculated and it predicted 3- and 12-month non-union risk. We identified risk factors for CS, some of which have strong effect sizes and are potentially modifiable.

Background: Optimal surgical treatment for recurrence of lumbar disc herniation (LDH) remains controversial, with options ranging from repeat microdiscectomy (MD) to instrumented fusion (IF). This study aimed to guide surgical decision-making by analyzing reoperation rates, clinical and radiographic risk factors for treatment failure, and functional outcomes following MD versus IF. Methods: Prospectively collected data from 450 patients in our outcomes database who underwent surgery for recurrent LDH from 2004 through 2023 were retrospectively analyzed. Clinical assessment included predominant symptoms, neurological deficits, and American Society of Anesthesiologists (ASA) grade. Radiographic assessment included disc height, Pfirrmann grade, facet angle, and Modic changes on magnetic resonance imaging, as well as spinopelvic parameters on standing radiographs. Patient-reported outcomes were assessed using the Core Outcome Measures Index (COMI) and achievement of the minimal clinically important change (MCIC) of ≥2.2 points. Propensity-score matching (PSM) was performed to control for confounding factors. Reoperation rates were analyzed with a minimum 5-year follow-up. Results: Of 450 patients with recurrent LDH, 316 (70.2%) underwent MD and 134 (29.8%) underwent IF. In 192 patients after PSM, IF showed nonsignificantly higher MCIC achievement (odds ratio [OR] = 1.20, 95% confidence interval [CI]: 0.66 to 2.17, p = 0.65) and lower COMI scores compared with the MD group (3.34 ± 2.89 versus 4.01 ± 2.95, p = 0.059; derived Oswestry Disability Index [ODI]: 23.8 versus 28.1). IF demonstrated significantly lower reoperation risk compared with MD (15.7% [116/316] versus 36.7% [21/34], p < 0.001). The reoperations following MD were predominantly subsequent IF (73.3%) and repeat MD (23.3%), while the reoperations after IF were predominantly adjacent segment surgery (57.1%) and hardware revision (33.3%). BMI of ≥35 kg/m ² was a significant predictor of reoperation after MD (univariate OR = 3.63, p = 0.039), while disc height of <6 mm (OR = 1.97) and Modic type-1 changes (OR = 1.78) showed trends toward increased reoperation risk (both p < 0.10). Conclusions: Although both procedures achieved clinical improvement, IF demonstrated superior long-term durability as shown by significantly lower reoperation rates over extended follow-up. Our findings support a risk-stratified surgical selection: IF should be strongly considered in patients with BMI of ≥35 kg/m ² and those with progressive disc degeneration, whereas MD remains appropriate for patients without these risk factors. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Background: Lateral lumbar or thoracic interbody fusion (LLIF) is increasingly considered for anterior column reconstruction and restoring segmental lordosis in degenerative, infectious, or deformity conditions. Reports about using LLIF with expandable interbody spacers for spine trauma are scarce. Methods: In this retrospective, single-center observational cohort study, we reviewed all patients treated by an expandable LLIF interbody spacer (ELSA^® Expandable Integrated LLIF Spacer, Globus Medical Inc) for trauma indication at our spine center between September 2018 and January 2024. The primary outcome measures were fusion rate at 12 months, change in segmental sagittal Cobb angle, and clinical outcome according to the MacNab criteria. Secondary outcomes included adverse events and complications. Results: We identified n = 21 patients with a mean age of 48.3 (standard deviation (SD) 15.7), 47.6% were female. LLIF was mostly performed at T11/12 (n = 4; 19.1%) and T12/L1 (n = 10; 47.5%). Indications were AO Spine type A2 (n = 4, 19.1%), A3 (n = 14; 66.7%) or A4 fractures (n = 3; 14.3%) with ligamentous (B2-type) in eight (38.1%) and hyperextension (B3-type) injury in one patient (4.8%). Surgery included the release of the anterior longitudinal ligament in four cases (19.1%). Intraoperative AEs were noted in n = 1 (4.8%), postoperative AEs in n = 3 (14.3%) at discharge, n = 4 (19.1%) at three, and n = 2 (9.5%) at twelve months. Segmental sagittal Cobb angle changed from 1.3° (preoperative) to 13.3° at twelve months (p < 0.001). Functional outcome was excellent/good in n = 15 (71.4%; four missing) at 12 months. The fusion rate at the LLIF level was 100% at the 12-month follow-up. Conclusions: LLIF with expandable interbody spacers for spine trauma (off-label use) is safe, promotes solid fusion (100% fusion rate at 12 months), and enables correction of sagittal segmental Cobb angle (mean improvement of 12°), with good or excellent clinical outcomes in most patients (71.4%).