{"doi":"10.1016/j.spinee.2025.07.018","title":"Static versus expandable transforaminal lumbar interbody fusion cages: a meta-analysis of complications, clinical, and radiographic outcomes","abstract":"<h2>Abstract</h2><h3>Background</h3> Surgical management of degenerative spinal disorders commonly includes lumbar interbody fusion. Transforaminal lumbar interbody fusion (TLIF) is an approach where the cages may be either static or expandable. However, published studies have reported disparate outcomes based on cage type. <h3>Purpose</h3> Therefore, this meta-analysis will compare the radiographic outcomes as well as the complications and clinical outcomes between static and expandable TLIF cages. <h3>Study design</h3> Meta-analysis <h3>Methods</h3> Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar (pages 1-20) were accessed and explored until December 2024. The extracted data consisted of complications (subsidence, radiculitis, adjacent segment disease, pseudoarthrosis, hardware failure, and durotomies), 90-day readmissions, reoperations, patient-reported outcomes measures (PROMs) at ≤ 3 months and ≥ 6 months, and improvement in radiographic parameters at ≥ 6 months. Heterogeneity was evaluated by Q tests and <i>I<sup>2</sup></i> statistics. If considerable heterogeneity was identified, a random-effects model was used. Otherwise, fixed-effect models were employed. <h3>Results</h3> Fifteen retrospective articles were included in the meta-analysis, including 2247 patients, with 1359 in the static TLIF group and 888 in the expandable TLIF group. While there was no difference in most of the assessed complications or 90-day readmission, patients in the static TLIF group had a trend towards a lower rate of subsidence (OR=0.50; 95% CI: 0.25–1.00, <i>p</i>=0.05) and a higher rate of reoperations (OR=1.96; 95% CI: 1.18–3.25, <i>p</i>=0.01). When examining PROMs, there was no significant difference in back or leg pain. However, the static TLIF group had worse ODI at ≥ 6 months (mean difference=3.77; 95% CI: 0.34–7.19, <i>p</i>=0.03). Furthermore, there was no difference in segmental lordosis improvement between the two groups. Nevertheless, the static TLIF group had less improvement in disc height (Standardized mean difference = -1.90; 95% CI: -2.98– -0.82, <i>p</i> < .001, <i>p</i> < .001), and foraminal height (Standardized mean difference=-3.76; 95% CI: -6.33– -1.19, <i>p</i>=0.004). <h3>Conclusion</h3> We found limited evidence of superior outcomes for most clinical parameters when comparing expandable to static TLIF. Surgeons should weigh anticipated benefits in case-specific scenarios against associated costs when selecting to use expandable devices.","journal":"The Spine Journal","year":2025,"id":521577,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":5,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9535,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1392405,"name":"Marven Aoun","orcid":null,"position":1,"is_corresponding":false},{"id":1392406,"name":"Richard K. Hurley","orcid":null,"position":2,"is_corresponding":false},{"id":1391909,"name":"William F. Lavelle","orcid":"0000-0003-2525-6080","position":3,"is_corresponding":false},{"id":764478,"name":"Bassel G. Diebo","orcid":"0000-0002-7835-2263","position":4,"is_corresponding":false},{"id":1391910,"name":"Amer Sebaaly","orcid":"0000-0002-2785-7835","position":5,"is_corresponding":false},{"id":498741,"name":"Andrew J. Schoenfeld","orcid":"0000-0002-3691-1215","position":6,"is_corresponding":false},{"id":769322,"name":"Alan H. Daniels","orcid":"0000-0001-9597-4139","position":7,"is_corresponding":false},{"id":1391908,"name":"Mohammad Daher","orcid":"0000-0002-9256-9952","position":0,"is_corresponding":true}],"reference_count":45,"raw_metadata":null,"created_at":"2026-07-19T02:49:44.558743Z","pmid":"40623528","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}