Focus of the Report: This report focuses on expandable interbody cages (EIC) for lumbar fusion in patients with degenerative disc disease (DDD).

Technology Description: Interbody fusion procedures involve the removal of a pathologic disc and insertion of interbody cages and bone grafts, with the aim of stabilizing the spine by fusing 2 or more vertebrae together. Interbody cages for spinal fusion may be composed of titanium or radiopaque polyetheretherketone. Static interbody spacers have traditionally been used for spinal fusion. EICs have been designed to be inserted at a minimal profile, then expanded while in the intervertebral space.

Controversy: Although spinal fusion has become a standard of surgical care for patients with DDD who have failed more conservative treatments and who meet other strict criteria, there remains controversy over the efficacy and safety of fusion, as well as the selection of which patients benefit most. The safety and effectiveness of EICs in comparison with static cages is not yet established.

Key Questions:

Are expandable interbody fusion devices/EICs effective in improving health outcomes in patients with DDD, spondylolisthesis, spinal stenosis, or other indications for spinal fusion?

  • How do expandable interbody fusion devices compare with other treatments for DDD?

  • Are expandable interbody fusion devices safe?

  • Have definitive patient selection criteria been established for use of EICs in patients with DDD or other indications for spinal fusion?

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