International Orthopaedics

, Volume 42, Issue 5, pp 1091–1097 | Cite as

Analysis of single cage position in transforaminal lumbar interbody fusion through digital images

  • Xin Zhao
  • Chen Chen
  • Tangjun Zhou
  • Jie Mi
  • Lin Du
  • Zhanrong Kang
  • Jianming Huang
  • Kai Zhang
  • Xiaojiang Sun
  • Jie ZhaoEmail author
Original Paper



The purpose of this study was to investigate the position of single cage inserted using oblique-oriented technique in transforaminal lumbar interbody fusion (TLIF) on digital images of computed tomography (CT).


From January to August 2015, 44 consecutive patients with degenerative lumbar disease who underwent TLIF in the L4/5 level were retrospectively studied in our department. The single cage was inserted using the oblique-oriented technique; as the main purpose of the study, its position was analyzed using post-operative digital computed tomography images.


All cages used in the study had the same length of 36 mm, which were inserted into the discs with a 46.04 ± 3.09-mm horizontal diameter and 34.25 ± 3.59-mm longitudinal diameter. The horizontal and longitudinal diameter of the treated disk established the coordinate. The horizontal and longitudinal coordinate values of the centre of the cage were 0.08 ± 4.12 and 1.20 ± 2.76 mm, respectively. The horizontal distance of the cage centre from the midpoint of the disc negatively correlated with that of the entry point from the midpoint of the disc in the coronal plane.


A longer single cage can be placed into the L4/5 level disk by inserting it using the oblique-oriented technique. Its center can reach the midpoint of the treated disk in the coronal plane and the anterior position of the disk in the sagittal plane. The entry point of the cage is the further away from the midpoint of the disk; the cage is the more apt to reach the center of the disk in the coronal plane.


Digital images TLIF Single cage Position 



This study is supported by National Natural Science Foundation of China “Biomechanical study of lumbar degeneration patterns in different spine sagittal curves” (81572168), China.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Murakami H, Horton WC, Tomita K, Hutton WC (2004) A two-cage reconstruction versus a single mega-cage reconstruction for lumbar interbody fusion: an experimental comparison. Eur Spine J 13:432–440 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Zhao J, Hai Y, Ordway NR, Park CK, Yuan HA (2000) Posterior lumbar interbody fusion using posterolateral placement of a single cylindrical threaded cage. Spine 25:425–430CrossRefPubMedGoogle Scholar
  3. 3.
    Murakami H, Horton WC, Kawahara N, Tomita K, Hutton WC (2001) Anterior lumbar interbody fusion using two standard cylindrical threaded cages, a single mega-cage, or dual nested cages: a biomechanical comparison. J Orthop Sci 6:343. CrossRefPubMedGoogle Scholar
  4. 4.
    Hackenberg L, Halm H, Bullmann V, Vieth V, Schneider M, Liljenqvist U (2005) Transforaminal lumbar interbody fusion: a safe technique with satisfactory three to five year results. Eur Spine J 14:551–558 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Xiao Y, Li F, Chen Q (2010) Transforaminal lumbar interbody fusion with one cage and excised local bone. Arch Orthop Trauma Surg 130:591–597 CrossRefPubMedGoogle Scholar
  6. 6.
    El-Masry MA, Khayal H, Salah H (2008) Unilateral transforaminal lumbar interbody fusion (TLIF) using a single cage for treatment of low grade lytic spondylolisthesis. Acta Orthop Belg 74:667–671PubMedGoogle Scholar
  7. 7.
    Zhou J, Wang B, Dong J, Li X, Zhou X, Fang T, Lin H (2011) Instrumented transforaminal lumbar interbody fusion with single cage for the treatment of degenerative lumbar disease. Arch Orthop Trauma Surg 131:1239 CrossRefPubMedGoogle Scholar
  8. 8.
    Fogel GR, Toohey JS, Neidre A, Brantigan JW (2007) Is one cage enough in posterior lumbar interbody fusion: a comparison of unilateral single cage interbody fusion to bilateral cages. J Spinal Disord Tech 20:60 CrossRefPubMedGoogle Scholar
  9. 9.
    Kai Z, Wei S, Zhao C, Hua L, Wei D, Xie Y, Sun X, Jie Z (2014) Unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in two-level degenerative lumbar disorders: a prospective randomised study. Int Orthop 38:111–116 CrossRefGoogle Scholar
  10. 10.
    Castellvi AD, Thampi SK, Cook DJ, Yeager MS, Yuan Y, Zou Q, Whiting DM, Oh MY, Prostko ER, Cheng BC (2015) Effect of TLIF cage placement on in vivo kinematics. Int J Spine Surg 9(38)
  11. 11.
    Quigley KJ, Alander DH, Bledsoe JG (2008) An in vitro biomechanical investigation: variable positioning of leopard carbon fiber interbody cages. J Spinal Disord Tech 21:442 CrossRefPubMedGoogle Scholar
  12. 12.
    Kim SB, Jeon TS, Heo YM, Lee WS, Yi JW (2009) Radiographic results of single level transforaminal lumbar interbody fusion in degenerative lumbar spine disease: focusing on changes of segmental lordosis in fusion segment. Clin Orthop Surg 1:207–213. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Ouldslimane M, Lenoir T, Dauzac C, Rillardon L, Hoffmann E, Guigui P, Ilharreborde B (2012) Influence of transforaminal lumbar interbody fusion procedures on spinal and pelvic parameters of sagittal balance. Eur Spine J 21:1200–1206. CrossRefGoogle Scholar
  14. 14.
    Chen WJ, Lai PL, Tai CL, Chen LH, Niu CC (2004) The effect of sagittal alignment on adjacent joint mobility after lumbar instrumentation—a biomechanical study of lumbar vertebrae in a porcine model. Clin Biomech 19:763–768. CrossRefGoogle Scholar
  15. 15.
    Kim KH, Lee SH, Shim CS, Lee DY, Park HS, Pan WJ, Lee HY (2010) Adjacent segment disease after interbody fusion and pedicle screw fixations for isolated L4-L5 spondylolisthesis: a minimum five-year follow-up. Spine 35:625–634 CrossRefPubMedGoogle Scholar
  16. 16.
    Mao L, Zhao J, Dai KR, Hua L, Sun XJ (2014) Bilateral decompression using a unilateral pedicle construct for lumbar stenosis. Int Orthop 38:573–578 CrossRefPubMedGoogle Scholar
  17. 17.
    Recnik G, Košak R, Vengust R (2013) Influencing segmental balance in isthmic spondylolisthesis using transforaminal lumbar interbody fusion. J Spinal Disord Tech 26:246–251 CrossRefPubMedGoogle Scholar
  18. 18.
    Fukuta S, Miyamoto K, Hosoe H, Shimizu K (2011) Kidney-type intervertebral spacers should be located anteriorly in cantilever transforaminal lumbar interbody fusion: analyses of risk factors for spacer subsidence for a minimum of 2 years. J Spinal Disord Tech 24:189. CrossRefPubMedGoogle Scholar
  19. 19.
    Kwon BK, Berta S, Daffner SD, Vaccaro AR, Hilibrand AS, Grauer JN, Beiner J, Albert TJ (2003) Radiographic analysis of transforaminal lumbar interbody fusion for the treatment of adult isthmic spondylolisthesis. J Spinal Disord Tech 16:469CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Xin Zhao
    • 1
  • Chen Chen
    • 1
  • Tangjun Zhou
    • 1
  • Jie Mi
    • 1
  • Lin Du
    • 1
  • Zhanrong Kang
    • 2
  • Jianming Huang
    • 2
  • Kai Zhang
    • 1
  • Xiaojiang Sun
    • 1
  • Jie Zhao
    • 1
    Email author
  1. 1.Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghaiPeople’s Republic of China
  2. 2.Department of Orthopaedics, Shanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina

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