{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T05:17:34Z","timestamp":1763702254808,"version":"3.45.0"},"reference-count":23,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Biportal endoscopic transforaminal lumbar interbody fusion (BESS-TLIF) is an emerging minimally invasive technique. This study aimed to evaluate the two-year radiological fusion outcomes of single-level BESS-TLIF using a specific banana-shaped, porous titanium interbody cage. Methods: This retrospective study reviewed 51 patients who underwent the specified procedure. The primary endpoint was the radiological fusion rate, assessed by computed tomography (CT) over 24 months using a three-grade system. Factors influencing fusion, particularly bone graft composition (demineralized bone matrix [DBM] only vs. DBM with I-factor), were also analyzed. Results: The final complete fusion rate at two years was 96.1% (49\/51; 95% Confidence Interval (CI), 86.5\u201399.5%). Bony fusion occurred predominantly in the posterior and intracage regions. The only significant factor influencing fusion was the bone graft material. The \u2018DBM with I-factor\u2019 group achieved complete fusion significantly faster than the \u2018DBM only\u2019 group (log-rank test, p &lt; 0.001), with a higher final fusion rate (100% vs. 83.3%, p = 0.045). Conclusions: Single-level BESS-TLIF using a banana-shaped, porous titanium cage provides favourable two-year radiological fusion rates. The selective addition of I-factor as an osteoinductive supplement can significantly accelerate the time to achieve solid arthrodesis.<\/jats:p>","DOI":"10.3390\/jcm14228091","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T16:46:22Z","timestamp":1763138782000},"page":"8091","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Two-Year Radiological Fusion Outcomes Following Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Using Banana-Shaped Interbody Cages"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7497-9077","authenticated-orcid":false,"given":"Sang-Bum","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Sejong 30099, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9320-0153","authenticated-orcid":false,"given":"Dong-Hwan","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Sejong 30099, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daehee","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Sejong 30099, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2696-4302","authenticated-orcid":false,"given":"Ja-Yeong","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Sejong 30099, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3171\/2019.4.SPINE18915","article-title":"State of the union: A review of lumbar fusion indications and techniques for degenerative spine disease","volume":"31","author":"Reid","year":"2019","journal-title":"J. Neurosurg. Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1177\/21925682221142545","article-title":"Comparison of Clinical Outcomes and Complications Between Endoscopic and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Diseases: A Systematic Review and Meta-analysis","volume":"13","author":"Guo","year":"2023","journal-title":"Glob. Spine J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"29652","DOI":"10.1038\/s41598-024-81402-1","article-title":"Comparison of clinical and radiologic outcomes between biportal endoscopic transforaminal lumbar interbody fusion and posterior lumbar interbody fusion","volume":"14","author":"You","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"275","DOI":"10.31616\/asj.2024.0425","article-title":"A Systematic Review of Biportal Endoscopic Spinal Surgery with Interbody Fusion","volume":"19","author":"Liawrungrueang","year":"2025","journal-title":"Asian Spine J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1177\/21925682231217253","article-title":"Efficacy and Outcome Measurement of iFactor\/ABM\/P-15 in Lumbar Spine Surgery: A Systematic Review","volume":"14","author":"Hasan","year":"2023","journal-title":"Glob. Spine J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"71","DOI":"10.4184\/jkss.2016.23.2.71","article-title":"Clinical Outcomes of a Zero Profile Implant for Single-Level Anterior Cervical Discectomy and Fusion","volume":"23","author":"Ha","year":"2016","journal-title":"J. Korean Soc. Spine Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.31616\/asj.2022.0435","article-title":"Lumbar Interbody Fusion and Osteobiologics for Lumbar Fusion","volume":"16","author":"Kim","year":"2022","journal-title":"Asian Spine J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"490","DOI":"10.31616\/asj.2024.0520","article-title":"Bone Fusion Materials: Past, Present, and Future","volume":"19","author":"Kim","year":"2025","journal-title":"Asian Spine J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1177\/21925682221090924","article-title":"Safety and Reoperation Rates in Non-instrumented Lumbar Fusion Surgery: Secondary Report From a Randomized Controlled Trial of ABM\/P-15 vs. Allograft With Minimum 5 years Follow-Up","volume":"14","author":"Andresen","year":"2024","journal-title":"Glob. Spine J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.tem.2015.01.004","article-title":"Anabolic Effects of PTH and the \u201cAnabolic Window\u201d","volume":"26","author":"Pazianas","year":"2015","journal-title":"Trends Endocrinol. Metab."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"463","DOI":"10.31616\/asj.2024.0505","article-title":"A Comprehensive Review of Risk Factors and Prevention Strategies: How to Minimize Mechanical Complications in Corrective Surgery for Adult Spinal Deformity","volume":"19","author":"Park","year":"2025","journal-title":"Asian Spine J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.1097\/00007632-199506020-00014","article-title":"Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects?","volume":"20","author":"Bridwell","year":"1995","journal-title":"Spine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1177\/2192568221993097","article-title":"The Significance of Extra-Cage Bridging Bone via Radiographic Lumbar Interbody Fusion Criterion","volume":"13","author":"Lee","year":"2023","journal-title":"Glob. Spine J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1186\/s13018-023-04393-1","article-title":"Comparing the efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion in lumbar degenerative diseases: A systematic review and meta-analysis","volume":"18","author":"Luan","year":"2023","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.wneu.2019.08.162","article-title":"Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion for Single-Level Degenerative Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"133","author":"Miller","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2031","DOI":"10.1177\/21925682231165709","article-title":"Transforaminal Lumbar Interbody Fusion with Double Banana Cages: Clinical Evaluations and Finite Element Model Analysis","volume":"14","author":"Fushimi","year":"2024","journal-title":"Global Spine J."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"van den Brink, W., and Lamerigts, N. (2020). Complete Osseointegration of a Retrieved 3-D Printed Porous Titanium Cervical Cage. Front. Surg., 7.","DOI":"10.3389\/fsurg.2020.526020"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"290","DOI":"10.3892\/etm.2024.12579","article-title":"Application of 3D-Printed Porous Titanium Interbody Fusion Cages versus Polyetheretherketone Cages in Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis Update","volume":"28","author":"Zhai","year":"2024","journal-title":"Exp. Ther. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1016\/j.spinee.2023.10.017","article-title":"Load distribution on intervertebral cages with and without posterior instrumentation","volume":"24","author":"Calek","year":"2024","journal-title":"Spine J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2841","DOI":"10.1177\/21925682251332558","article-title":"Response to Letter to the Editor Regarding the Article Entitled \u201cTrabecular Bone Remodeling After Posterior Lumbar Interbody Fusion: Comparison of the Osseointegration in Three-Dimensional Porous Titanium Cages and Polyether-Ether-Ketone Cages\u201d by Segi et al","volume":"15","author":"Segi","year":"2025","journal-title":"Glob. Spine J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1007\/s00586-003-0556-5","article-title":"The importance of the endplate for interbody cages in the lumbar spine","volume":"12","author":"Polikeit","year":"2003","journal-title":"Eur. Spine J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s40634-018-0165-1","article-title":"Biomechanical evaluation of two minimal access interbody cage designs in a cadaveric model","volume":"5","author":"Kok","year":"2018","journal-title":"J. Exp. Orthop."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"178","DOI":"10.21037\/jss.2016.09.08","article-title":"The importance of loading the periphery of the vertebral endplate","volume":"2","author":"Cadman","year":"2016","journal-title":"J. Spine Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/22\/8091\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T05:10:29Z","timestamp":1763701829000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/22\/8091"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,14]]},"references-count":23,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14228091"],"URL":"https:\/\/doi.org\/10.3390\/jcm14228091","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,11,14]]}}}