Radiographic factors affecting lordosis correction after transforaminal lumbar interbody fusion with unilateral facetectomy

Christopher T. Martin, Shuo Niu, Emily Whicker, Laura Ward, S. Tim Yoon

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

BACKGROUND: The study design was a retrospective cohort study. The objective was to identify preoperative (preop) radiographic features that are associated with increased lordosis correction after transforaminal lumbar interbody fusion (TLIF).

METHODS: We retrospectively reviewed a single surgeon series of TLIF performed at L4-5 since 2010. The surgical technique involved unilateral facetectomy and insertion of a banana-type cage. A total of 107 cases were available with plain radiographs, and 62 with a preop computed tomography (CT) scan. We compared segmental lordosis correction between the preop and 6-week postoperative radiographs. Patients were divided into groups of those with or without more than 5° lordosis correction. Radiographic features were then compared, and a multivariate analysis was performed.

RESULTS: The mean lordosis correction of the entire cohort was 2.5° (range = -9° to 16°). The percentage of patients with a vacuum disc on the preop CT (40% vs 10%, P = 0.01) was higher in the group with greater than 5° lordosis correction, whereas the mean preop segmental lordosis (14.3° vs 18.6°) and the preop segmental disc angle (6.4° vs 8.4°) were both lower ( P < 0.05 for each). The percentage of patients with a Meyerding grade of 2 or higher (28% vs 16%) trended higher but was not significant ( P = 0.1). There was no significant difference in the mean body mass index, patient age, preop lumbar lordosis, or disc space height.

CONCLUSIONS: Patients with a preop vacuum disc sign on CT scan or those with a more kyphotic disc space on preop radiographs were more likely to achieve lordosis correction. This information may be useful in preop planning.

LEVEL OF EVIDENCE: 4.

CLINICAL RELEVANCE: Unilateral TLIF is likely to be neutral or kyphogenic in patients with a segmental disc angle that is neutral or lordotic pre-operatively, but is likely to increase segmental lordosis in patients with a disc angle that is kyphotic pre-oepratively.

Original languageEnglish (US)
Pages (from-to)681-686
Number of pages6
JournalInternational Journal of Spine Surgery
Volume14
Issue number5
DOIs
StatePublished - Oct 1 2020

Bibliographical note

Publisher Copyright:
© International Society for the Advancement of Spine Surgery

Keywords

  • Deformity
  • Lordosis
  • Segmental alignment
  • TLIF

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