𝗘𝘅𝗽𝗮𝗻𝗱𝗮𝗯𝗹𝗲 𝗧𝗟𝗜𝗙 𝗖𝗮𝗴𝗲𝘀 — 𝗚𝗿𝗲𝗮𝘁 𝗠𝗮𝗿𝗸𝗲𝘁𝗶𝗻𝗴, 𝗼𝗿 𝗚𝗿𝗲𝗮𝘁 𝗠𝗲𝗱𝗶𝗰𝗶𝗻𝗲?

A recent Spine Journal study comparing expandable vs. static TLIF cages caught my attention (https://pubmed.ncbi.nlm.nih.gov/39349256/).

𝗪𝗵𝗮𝘁 𝗶𝘁 𝗳𝗼𝘂𝗻𝗱:

𝗦𝗵𝗼𝗿𝘁-𝘁𝗲𝗿𝗺 𝘄𝗶𝗻: Expandables bumped disc height at 2 weeks and 6 months.

𝗟𝗼𝗻𝗴-𝘁𝗲𝗿𝗺 𝗿𝗲𝗮𝗹𝗶𝘁𝘆: That ad

vantage vanished by 1 year.

𝗟𝗼𝗿𝗱𝗼𝘀𝗶𝘀: No difference in segmental or L4–S1 lordosis.

𝗦𝘂𝗯𝘀𝗶𝗱𝗲𝗻𝗰𝗲: Nearly double with expandables (14.1% vs. 6.6%).

𝗖𝗼𝗺𝗽𝗹𝗶𝗰𝗮𝘁𝗶𝗼𝗻𝘀: No other meaningful differences.

From where I sit, and I have no horse in this race, this begs a blunt question:

𝗔𝗿𝗲 𝗲𝘅𝗽𝗮𝗻𝗱𝗮𝗯𝗹𝗲𝘀 𝗱𝗲𝗹𝗶𝘃𝗲𝗿𝗶𝗻𝗴 𝗿𝗲𝗮𝗹, 𝗱𝘂𝗿𝗮𝗯𝗹𝗲 𝗽𝗮𝘁𝗶𝗲𝗻𝘁 𝗯𝗲𝗻𝗲𝗳𝗶𝘁—𝗼𝗿 𝗵𝗮𝘃𝗲 𝘄𝗲 𝗮𝗹𝗹 𝗷𝘂𝘀𝘁 𝗯𝗼𝘂𝗴𝗵𝘁 𝗶𝗻𝘁𝗼 𝗮 𝗰𝗼𝗺𝗽𝗲𝗹𝗹𝗶𝗻𝗴 𝗽𝗿𝗼𝗱𝘂𝗰𝘁 𝘀𝘁𝗼𝗿𝘆?

𝗧𝗵𝗲 𝗱𝗮𝘁𝗮 𝗵𝗲𝗿𝗲 𝘀𝘂𝗴𝗴𝗲𝘀𝘁𝘀:

The “lasting height” advantage isn’t holding up.

Subsidence risk is higher.

Costs are typically greater.

I have heard static cage proponents, saying technique—anterior placement, full discectomy, and proper compression—gets them the height and lordosis without the trade-offs.

So I’ll put it to the people doing the work:

Are you seeing sustained radiographic or clinical advantages with expandables beyond 18 and 24 months? How do you keep subsidence in check?

Are there specific patient scenarios where expandables outperform statics? I’m certainly not going to settle the debate—just curious to hear from those who live it every day.

What’s your experience? Join the discussion on LinkedIn: https://www.linkedin.com/posts/activity-7360789108476030976-HeOu?utm_source=share&utm_medium=member_desktop&rcm=ACoAAADy0T4BoQxFNJ6EQJn_B93cRRLuvK2uSh0