High Fusion Rates with Structured Titanium TLIF Cages: A Retrospective 1-Year Study with and Without Adjacent Level Dynamic Stabilization

Background: Structured titanium (ST) cages are designed to enhance osseointegration and fusion in lumbar interbody procedures. However, clinical and radiological outcomes following TLIF using ST cages—particularly with or without adjacent-level dynamic stabilization (DSS)—have not been widely reported. Objective: To evaluate 12-month fusion outcomes and patient-reported outcomes (PROMs) after TLIF with structured titanium cages, comparing cases with and without adjacent-level DSS. Methods: In this retrospective cohort study, 82 patients undergoing TLIF with ST cages were analyzed—41 with hybrid instrumentation (TLIF + DSS) and 41 with TLIF alone. PROMs (ODI, VAS for back and leg pain, EQ-5D-5L) were assessed preoperatively and at 12 months. Fusion was assessed via CT scans at 12 months. Results: PROMs significantly improved over time in both groups (p < 0.001 for ODI, VAS back, VAS leg), but there were no significant differences between the hybrid and non-hybrid groups. Overall, the interbody fusion rate was 84%. Complete fusion was observed in 84% of the hybrid group and 80% of the TLIF-only group (p = 0.716), with very low rates of non-union. Conclusions: Structured titanium cages demonstrated excellent 1-year fusion rates and supported significant clinical improvement after TLIF. The addition of dynamic stabilization had no measurable effect on patient-reported or radiological outcomes at 12 months. Long-term studies are needed to assess any potential effect of DSS on adjacent segment disease.