title: Single transverse-orientation cage via MIS-TLIF approach for the treatment of degenerative lumbar disease: a technical note.
abstract: BACKGROUND
  Single transverse cage placed in the anterior vertebral column can better maintain lumbar lordosis and sagittal alignment and is frequently used via the lateral transpsoas approach. However, there is no clear description in the literature of the steps required to place the single transverse cage during the instrumented transforaminal lumbar interbody fusion (TLIF) procedure for the treatment of degenerative lumbar disease. The objective of this study is to describe the technique using single transverse-orientation cage when performing TLIF procedures.
  
  
  METHODS
  We present 18 illustrative cases in which single transverse-orientation cage was placed according to a step-by-step technique that can be used during the TLIF procedure. Information acquired included procedure time, intraoperative blood loss and postoperative complications. The preoperative and postoperative Oswestry Disability Index (ODI) and the visual analogue scale (VAS) scores were recorded. Changes in disc height and segmental lordosis were measured at radiographs.
  
  
  RESULTS
  The single transverse-orientation cage was successfully placed in 18 patients in a stepwise technique to achieve lumbar fusion. Using this technique, the patients significantly improved clinically and radiographically at postoperative visits.
  
  
  CONCLUSIONS
  This is the first report demonstrating the safety and efficacy of instrumented TLIF with single transverse-orientation cage for the treatment of degenerative lumbar disease. Single transverse-orientation cage via MIS-TLIF approach can maintain greater lumbar lordosis and avoid the unique complications of lateral transpsoas approach. Understanding the options for cage placement is important for surgeons considering the use of this technique.
authors.affiliation: Departments of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine Shanghai, China.
authors.forename: Shan-Jin
authors.initials: SJ
authors.lastname: Wang
authors.affiliation: Departments of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine Shanghai, China.
authors.forename: Ying-Chao
authors.initials: YC
authors.lastname: Han
authors.affiliation: Departments of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine Shanghai, China.
authors.forename: Fu-Min
authors.initials: FM
authors.lastname: Pan
authors.affiliation: Departments of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine Shanghai, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Ma
authors.affiliation: Departments of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine Shanghai, China ; Department of Orthopedics, Pinghu Second People's Hospital Jiaxing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Tan
keywords: Spinal fusion; TLIF; degenerative lumbar disease; interbody cage