Expandable Lateral Lumbar Cages With Integrated Fixation: A Viable Option for Rostral Adjacent Segment Disease
Bibliographic record
Abstract
BACKGROUND: Adjacent segment disease (ASD) above a previous posterior lumbar instrumented fusion can be managed with minimally invasive lateral lumbar interbody fusion. Earlier procedures with stand-alone lateral cages risked nonunion, and lateral cages with separate lateral plates risked lumbar plexus injury and vertebral fracture. We investigated clinical and radiographic outcomes of an expandable lateral titanium interbody cage with an integrated lateral fixation (eLLIFp) device as a stand-alone treatment for symptomatic ASD above a previous posterior lumbar fusion and performed a comparative cost analysis of eLLIFp to alternative operations for ASD. METHODS: In this prospective, observational study, patients with ASD above 1-, 2-, 3-, or 4-level instrumented posterior fusions underwent surgery with lateral expandable titanium cage(s) with an integrated lateral plate with single screws into each adjacent vertebra from August 2017 to August 2019. Multimodality intraoperative neural monitoring was performed. Patient-reported outcomes, computed tomography outcomes, and total costs were analyzed. RESULTS: A total of 33 patients received 35 eLLIFp cages. All clinical outcomes improved significantly. The eLLIFp cages added 2.2° segmental lordosis and 2.7 mm posterior disc height. Interbody fusion rate was 94% at 12 months. There were 2 neurologic complications (6%): 1 patient reported transient anterior thigh numbness and 1 had mild persistent L4 radiculopathy. No cage subsidence, cage migration, screw loosening, or vertebral fracture occurred. No revision lateral surgery, posterior decompression, or supplemental posterior fixation was required. The total eLLIFp cost (AU$19,715) was lower than the cost for all other procedures. CONCLUSIONS: eLLIFp provided a minimally invasive, low morbidity, cost-effective, and robust alternative to traditional posterior construct extension surgery for rostral lumbar ASD in selected patients with 1- to 2-level stenosis and minimal deformity. CLINICAL RELEVANCE: Traditional ASD treatment involves substantial risks and expense. eLLIFp should be considered a safe, effective, and lower cost alternative to posterior construct extension surgery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".