{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T20:35:02Z","timestamp":1777581302204,"version":"3.51.4"},"reference-count":29,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T00:00:00Z","timestamp":1614816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Symptomatic adjacent segment degeneration (ASD) with lumbar spinal canal stenosis (LSCS) is a common complication after spinal intervention, particularly interbody fusion. Stand-alone posterior expandable cages enable interbody fusion with preservation of the previous operation site, and screw-related complications are avoided. Thus, the aim of this study was to investigate the clinicoradiologic outcomes of stand-alone posterior expandable cages for ASD with LSCS. Materials and Methods: Patients with persistent neurologic symptoms and radiologically confirmed ASD with LSCS were evaluated between January 2011 and December 2016. The five-year follow-up data were used to evaluate the long-term outcomes. The radiologic parameters for sagittal balance, pain control (visual analogue scale), disability (Oswestry Disability Index), and early (peri-operative) and late (implant) complications were evaluated. Results: The data of 19 patients with stand-alone posterior expandable cages were evaluated. Local factors, such as intervertebral and foraminal heights, were significantly corrected (p &lt; 0.01 and p &lt; 0.01, respectively), and revision was not reported. The pain level (p &lt; 0.01) and disability rate (p &lt; 0.01) significantly improved, and the early complication rate was low (n = 2, 10.52%). However, lumbar lordosis (p = 0.62) and sagittal balance (p = 0.80) did not significantly improve. Furthermore, the rates of subsidence (n = 4, 21.05%) and retropulsion (n = 3, 15.79%) were high. Conclusions: A stand-alone expandable cage technique should only be considered for older adults and patients with previous extensive fusion. Although this technique is less invasive, improves the local radiologic factors, and yields favorable clinical outcomes with low revision rates, it does not improve the sagittal balance. For more widespread application, the strength of the cage material and high subsidence rates should be improved.<\/jats:p>","DOI":"10.3390\/medicina57030237","type":"journal-article","created":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T21:58:07Z","timestamp":1614895087000},"page":"237","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Stand-Alone Posterior Expandable Cage Technique for Adjacent Segment Degeneration with Lumbar Spinal Canal Stenosis: A Retrospective Case Series"],"prefix":"10.3390","volume":"57","author":[{"given":"Woo-Jin","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Spine Center, Hurisarang Hospital, 618 Gyeryong-ro, Seo-gu, Daejeon 35299, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4632-521X","authenticated-orcid":false,"given":"Seung-Kook","family":"Kim","sequence":"additional","affiliation":[{"name":"Himchan and UHS Spine and Joint Centre, Neurosurgery, University Hospital Sharjah, University Street 1, Sharjah 72772, United Arab Emirates"},{"name":"Department of Pharmaceutical Medicine and Regulatory Sciences, College of Medicine and Pharmacy, Yonsei University, 85, Songdokwahak-ro, Yeonsu-gu, Incheon 21983, Korea"},{"name":"Joint and Arthritis Research, Orthopaedic Surgery, Himchan Hospital, 20, Sinmok-ro, Yangcheon-gu, Seoul 07999, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manhal","family":"Alaraj","sequence":"additional","affiliation":[{"name":"Himchan and UHS Spine and Joint Centre, Neurosurgery, University Hospital Sharjah, University Street 1, Sharjah 72772, United Arab Emirates"},{"name":"Department of Orthopedic Surgery, University Hospital Sharjah, University Street 1, Sharjah 72772, United Arab Emirates"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyeun-Sung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Spine Center, Gangnam Nanoori Hospital, Gangnam, Seoul 06048, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Su-Chan","family":"Lee","sequence":"additional","affiliation":[{"name":"Joint and Arthritis Research, Orthopaedic Surgery, Himchan Hospital, 20, Sinmok-ro, Yangcheon-gu, Seoul 07999, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1007\/s00586-009-1060-3","article-title":"Risk factors for adjacent segment disease after lumbar fusion","volume":"18","author":"Lee","year":"2009","journal-title":"Eur. Spine J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1007\/s00586-013-3132-7","article-title":"Pelvic incidence-lumbar lordosis mismatch results in increased segmental joint loads in the unfused and fused lumbar spine","volume":"23","author":"Senteler","year":"2014","journal-title":"Eur. Spine J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1097\/01.brs.0000137069.88904.03","article-title":"Adjacent segment disease after lumbar or lumbosacral fusion: Review of the literature","volume":"29","author":"Park","year":"2004","journal-title":"Spine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"E1461","DOI":"10.1097\/BRS.0000000000003191","article-title":"Comparison of stand-alone lateral lumbar interbody fusion versus open laminectomy and posterolateral instrumented fusion in the treatment of adjacent segment disease following previous lumbar fusion surge","volume":"44","author":"Louie","year":"2009","journal-title":"Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"E519","DOI":"10.1097\/00007632-200111150-00024","article-title":"Surgical treatment of adjacent instability after lumbar spine fusion","volume":"26","author":"Chen","year":"2001","journal-title":"Spine"},{"key":"ref_6","first-page":"546","article-title":"Sagittal alignment as a risk factor for adjacent level degeneration: A case-control study","volume":"31","author":"Djurasovic","year":"2008","journal-title":"Orthopedics."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"9","DOI":"10.21037\/jss.2017.02.05","article-title":"One and two level posterior lumbar interbody fusion (PLIF) using an expandable, stand-alone, interbody fusion device: A VariLift\u00ae case series","volume":"3","author":"Block","year":"2017","journal-title":"J. Spine Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"251","DOI":"10.3340\/jkns.2007.42.4.251","article-title":"A multi-center clinical study of posterior lumbar interbody fusion with the expandable stand-alone cage (Tyche\u00ae cage) for degenerative lumbar spinal disorders","volume":"42","author":"Kim","year":"2007","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"15","DOI":"10.14444\/3015","article-title":"Treatment of symptomatic lumbar disc degeneration with the VariLift-L interbody fusion system: Retrospective review of 470 cases","volume":"10","author":"Neely","year":"2016","journal-title":"Int. J. Spine Surg."},{"key":"ref_10","first-page":"29","article-title":"Adjacent segment degeneration following spinal fusion for degenerative disc disease","volume":"65","author":"Levin","year":"2007","journal-title":"Bull. NYU Hosp. Jt. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s00264-014-2516-6","article-title":"Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: A literature review","volume":"39","author":"Faundez","year":"2015","journal-title":"Int. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1097\/BRS.0b013e3182217ab5","article-title":"Major complications in revision adult deformity surgery: Risk factors and clinical outcomes with 2- to 7-year follow-up","volume":"37","author":"Cho","year":"2012","journal-title":"Spine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e12680","DOI":"10.1097\/MD.0000000000012680","article-title":"Comparing stand-alone oblique lumbar interbody fusion with posterior lumbar interbody fusion for revision of rostral adjacent segment disease: A STROBE-compliant study","volume":"97","author":"Zhu","year":"2018","journal-title":"Medicine"},{"key":"ref_14","first-page":"305","article-title":"Junctional disc herniation syndrome in post spinal fusion treated with endoscopic spine surgery","volume":"14","author":"Chiu","year":"2005","journal-title":"Surg. Technol. Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s12178-016-9355-6","article-title":"Role of minimally invasive surgery for adult spinal deformity in preventing complications","volume":"9","author":"Yen","year":"2016","journal-title":"Curr. Rev. Musculoskelet Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1097\/BRS.0b013e31827c99f0","article-title":"Risk for adjacent segment and same segment reoperation after surgery for lumbar stenosis: A subgroup analysis of the Spine Patient Outcomes Research Trial (SPORT)","volume":"38","author":"Radcliff","year":"2013","journal-title":"Spine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"190","DOI":"10.3171\/2014.12.SPINE14666","article-title":"Reduction in adjacent-segment degeneration after multilevel posterior lumbar interbody fusion with proximal DIAM implantation","volume":"23","author":"Lu","year":"2015","journal-title":"J. Neurosurg. Spine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"617","DOI":"10.3171\/2014.2.SPINE13548","article-title":"Posterior lumbar interbody fusion with stand-alone trabecular metal cages for repeatedly recurrent lumbar disc herniation and back pain","volume":"20","author":"Lequin","year":"2014","journal-title":"J. Neurosurg. Spine"},{"key":"ref_19","first-page":"170","article-title":"Clinical results of a single central interbody fusion cage and transpedicle screws fixation for recurrent herniated lumbar disc and low-grade spondylolisthesis","volume":"26","author":"Huang","year":"2003","journal-title":"Chang Gung Med. J."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Tsai, T.T., Lee, S.H., Niu, C.C., Lai, P.L., Chen, L.H., and Chen, W.J. (2016). Unplanned revision spinal surgery within a week: A retrospective analysis of surgical causes. BMC Musculoskelet Disord., 17.","DOI":"10.1186\/s12891-016-0891-4"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/j.wneu.2017.01.089","article-title":"Comparison of three minimally invasive spine surgery methods for revision surgery for recurrent herniation after percutaneous endoscopic lumbar discectomy","volume":"100","author":"Yao","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1007\/s00586-006-0284-8","article-title":"Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion","volume":"16","author":"Barsa","year":"2007","journal-title":"Eur. Spine J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1097\/BSD.0b013e3181af3a84","article-title":"Outcomes of interbody fusion cages used in 1 and 2-levels anterior cervical discectomy and fusion: Titanium cages versus polyetheretherketone (PEEK) cages","volume":"23","author":"Niu","year":"2010","journal-title":"J. Spinal Disord. Technol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/BF01809274","article-title":"Anterior cervical discectomy and vertebral interbody fusion with hydroxy-apatite ceramic. Preliminary results","volume":"121","author":"Schultheiss","year":"1993","journal-title":"Acta Neurochir."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1016\/j.spinee.2018.02.018","article-title":"Bony ingrowth potential of 3D-printed porous titanium alloy: A direct comparison of interbody cage materials in an in vivo ovine lumbar fusion model","volume":"18","author":"McGilvray","year":"2018","journal-title":"Spine J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.wneu.2016.07.074","article-title":"Association between vitamin D deficiency and outcomes following spinal fusion surgery: A systematic review","volume":"95","author":"Kerezoudis","year":"2016","journal-title":"World Neurosurg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1007\/s00586-015-4342-y","article-title":"An effect comparison of teriparatide and bisphosphonate on posterior lumbar interbody fusion in patients with osteoporosis: A prospective cohort study and preliminary data","volume":"26","author":"Cho","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1016\/j.otsr.2018.07.015","article-title":"Combined teriparatide and denosumab therapy accelerates spinal fusion following posterior lumbar interbody fusion","volume":"104","author":"Ide","year":"2018","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1007\/s00586-003-0667-z","article-title":"Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion: A prospective study with respect to bone union pattern","volume":"13","author":"Suchomel","year":"2004","journal-title":"Eur. Spine J."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/3\/237\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:32:46Z","timestamp":1760160766000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/3\/237"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,4]]},"references-count":29,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["medicina57030237"],"URL":"https:\/\/doi.org\/10.3390\/medicina57030237","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,4]]}}}