Minimally Invasive Lumbar Interbody Fusion With an Expandable Meshed Allograft Containment Device: Analysis of Subsidence With 12-Month Minimum Follow-Up

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ABSTRACT Background: We have previously reported the use of a minimally invasive allograft-filled expandable meshed-bag containment system in the lumbar spine. Subsidence has not been reported with this device. In this retrospective case series, we describe subsidence after lumbar interbody fusion using this device, with 12-month minimum radiographic follow-up. Methods: Consecutive adult patients that underwent 1- or 2-level interbody fusion with at least 1 year of follow-up were included in this study. Preoperative, postoperative, and final follow-up lumbar radiographs were analyzed to measure disc height at the anterior and posterior margins of the disc space, as well as the neuroforaminal height. Results: Forty-one patients were identified, with a mean age of 63.4 years (± 11.8). A total of 61 levels were treated, with successful fusion observed in 54 levels (88.5%). The mean radiographic follow-up was 24.3 months (± 11.2). The mean disc height pre- and postoperatively was 6.9 mm (± 3.2) and 10.1 mm (± 2.9, P < .001), respectively. The mean disc height at final follow-up was 8.3 mm (± 2.4). Average disc height subsidence was 1.8 mm (± 1.7, P < .001). Overall, average disc height increased by a net 1.3 mm (± 2.5, P < .001). The mean neuroforaminal height pre- and postoperatively was 18.0 mm (± 3.3) and 20.7 mm (± 3.6, P < .001), respectively. The mean neuroforaminal height at final follow-up was 19.2 mm (± 3.4). Average neuroforaminal height subsidence was 1.3 mm (± 3.4, P = .012). Overall, average neuroforaminal height increased by a net 1.7 mm (± 2.8, P = .004). No significant difference in subsidence was observed between 1- and 2-level surgeries. Conclusion: An expandable allograft containment system is a feasible alternative for lumbar interbody fusion. Due to its biologic and mechanical nature, the surgeon using such constructs should account for an anticipated average of 18% loss of interbody height due to subsidence during the bony remodeling/fusion process.

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