Issue link: https://beckershealthcare.uberflip.com/i/1425344
17 Executive Briefing SPONSORED BY F or years, spine surgeons encountered multiple challenges using static interbody cages in procedures. The desire to minimize these challenges led to the development of expandable interbody cages. To better understand the advantages of expandable interbody cages — and specifically the advantages of the Catalyft™ PL expandable interbody device — Becker's Spine Review recently spoke with two leading spine surgeons who have experience using the Catalyft™ PL expandable interbody device: • Christopher Holland, MD, PhD, neurosurgeon, Carolina Neurosurgery & Spine Associates in Concord, N.C. • Sharad Rajpal, MD, board-certified neurosurgeon, Boulder (Colorado) Neurosurgical and Spine Associates Dr. Holland and Dr. Rajpal responded to a series of questions about their experiences with the Catalyft™ PL expandable interbody device. Both of their responses are summarized below, with minor edits for clarification. Question: The development of expandable interbody cages arose due to common challenges associated with static interbody cages when restoring lordosis/ sagittal alignment. How does the Catalyft™ PL expandable interbody device help minimize those common challenges? Dr. Christopher Holland: Historically, the inability to improve lordosis had been a major criticism of MIS TLIF procedures. The Catalyft™ PL expandable interbody device can securely expand to up to 22 degrees of lordosis in a continuous fashion while auto-locking at any position. The Catalyft™ PL expandable interbody device provides the lordotic expansion necessary to help us achieve desired improvements in segmental and global lumbar lordosis, and therefore, overall sagittal alignment. Dr. Sharad Rajpal: Placing an interbody cage from a posterior approach has unique challenges when compared to its anterior and lateral cage counterparts. The biggest concerns for spine surgeons when approaching the spine posteriorly include using an interbody cage that is small enough to be inserted without causing injury to the dura and/or neural elements, but is large enough to "fill" the interbody space, to promote bony fusion and to restore or maintain lordosis/sagittal alignment. With the design of the expandable Catalyft™ PL expandable interbody device, I feel the ease of insertion comes from the matching footprint of the cage true to the size of the trials and the nicely designed anterior beveled tip. Once deployed within the disc space, the Catalyft™ PL40 cage has a longer length, compared to Catalyft™ PL expandable interbody device, and a continuous angular adjustment up to 22 degrees that allows the maintenance and restoration of lordosis and sagittal alignment. Q: The design of the Catalyft™ PL40 expandable interbody device offers similar anterior rim apophyseal contact commonly achieved using a banana-shaped cage but with the ease of insertion associated with a straight or football-shaped cage. Why is this design feature of interest to you as a spine surgeon? CH: The Catalyft™ PL40 expandable interbody device design maximizes the interface between the cage and the anterior apophyseal ring to facilitate correction and reduce the likelihood of subsidence. The insertion of banana-shaped interbody devices can be challenging, particularly with an MIS approach. This can be exacerbated further at the L5-S1 disc space where the iliac crest can further limit the placement trajectory of the interbody cage. Catalyft™ PL40 expandable interbody device allows for similar engagement of the anterior apophyseal ring with a direct oblique or bilateral PLIF trajectory. SR: I think the unique design of the Catalyft™ PL40 expandable interbody device allows greater flexibility to spine surgeons who have different interbody cage type preferences. Surgeons often prefer one particular interbody cage design over another because of how it may address that surgeon's specific needs and concerns. With the Catalyft™ PL40's hybrid design which includes 40 percent more surface area compared to Catalyft™ PL expandable interbody device, I think it gives spine surgeons with a preference for the "straight in" or "football" cage designs the ability to benefit from the additional feature of the "banana" cage with the increased anterior contact and greater surface area to reduce subsidence. Q: The Catalyft™ PL expandable interbody device is compatible with the StealthStation™ S8 navigation system and allows the surgeon to see the implant in the collapsed and expanded positions during placement. How does this feature aid in executing your surgical plan? SR: One of my favorite features of the Catalyft™ PL cage includes its compatibility with the StealthStation™ S8 navigation system because I appreciate the precise information this technology provides me with both planning and execution of my surgical plan. How to address the common challenges associated with static interbody cages — Insights from Drs. Holland & Rajpal