Preliminary Results of Expandable Transforaminal Lumbar Interbody Fusion Cages

Kyriakos Kitsopoulos1, Bernd Wiedenhoefer2, Stefan Hemmer3, Christoph Fleege1, Mohammad Arabmotlagh4, Michael Rauschmann4, Marcus Rickert5, *
1 Orthopaedische Universitaetsklinik Friedrichsheim gGmbH, Marienburgstrasse 2, 60528, Frankfurt am Main, Germany
2 Zentrum für Wirbelsäulenchirurgie, ATOS Klinik Heidelberg, Bismarckstraße 9-15, 69115, Heidelberg, Germany
3 Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
4 Klinik für Wirbelsäulenorthopädie und Rekonstruktive Orthopädie, Sana Klinik Offenbach, Starkenburgring 66, 63150, Offenbach am Main, Germany
5 Schoen Clinic Lorsch, Wilhelm-Leuschner-Straße 10, 64653 Lorsch, Germany

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© 2021 Kitsopoulos et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at: Schoen Clinic Lorsch, Wilhelm-Leuschner-Straße 10, 64653 Lorsch, Germany; Tel: +49 6251 591307; E-mail:



Compared with static cages, expandable cages for Transforaminal Lumbar Interbody Fusion (TLIF), are thought to require less posterior bony removal and nerve root retraction. They may allow the creation of a greater lordotic angle and lordosis restoration.


This study investigated whether TLIF using an expandable lordotic interbody cage facilitates an improvement in both segmental lordosis and the restoration of intradiscal height.


A total of 32 patients with 40 operated segments underwent TLIF surgery for lumbar degenerative disc disease and were consecutively included in this prospective observational study. Of those patients, 25 received monosegmental treatment, six were treated bisegmentally, and one was treated trisegmentally. All patients were assessed clinically and radiographically preoperatively, as well as one week, six months, and two years postoperatively.


Two patients required revision for screw loosening and pseudarthrosis. In four patients, the endplate was violated intraoperatively due to cage placement. Postoperatively, cage subsidence was observed in four patients. Significant improvement in the mean degree of spondylolisthesis was noted at the two-year mark. Mean segmental lordosis improved postoperatively. A significant increase in mean disc height of the treated segment was also found. Overall, with the exception of pain, no significant clinical or radiographic changes were reported between the first postoperative week and the two-year year follow-up mark. The mean pain, functional, and quality of life outcomes improved significantly from the preoperative to postoperative period, with no deterioration between six months and two years.


This study demonstrates that favorable outcomes can be achieved by using an expandable titanium cage in TLIF procedures.

Keywords: Clinical outcome, Degenerative disc disease, Expandable cage, Lumbar spine, Spinal column reconstruction, Spondylodesis, Transforaminal lumbar interbody fusion.