What Affects Segmental Lordosis of the Surgical Site after Minimally Invasive Transforaminal Lumbar Interbody Fusion?

Abstract

Purpose This study was undertaken to identify factors that affect segmental lordosis (SL) after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) by comparing patients whose postoperative SL increased with those whose decreased. Materials and Methods Fifty-five patients underwent MIS-TLIF at our institute from January 2018 to September 2019. Demographic, pre- and postoperative radiologic, and cage-related factors were included. Statistical analyses were designed to compare patients whose SL increased with decreased after surgery. Results After surgery, SL increased in 34 patients (group I) and decreased in 21 patients (group D). The index level, disc lordosis, SL, lumbar lordosis, proximal lordosis (PL), and Y-axis position of the cage (Yc) differed significantly between groups I and D. The cage in group I was more anterior than that in group D (Yc: 55.84% vs. 51.24%). Multivariate analysis showed that SL decreased more significantly after MIS-TLIF when the index level was L3/4 rather than L4/5 [odds ratio (OR): 0.46, p =0.019], as preoperative SL (OR: 0.82, p =0.037) or PL (OR: 0.68, p =0.028) increased, and as the cage became more posterior (OR: 1.10, p =0.032). Conclusion Changes in SL after MIS-TLIF appear to be associated with preoperative SL and PL, index level, and Yc. An index level at L4/5 instead of L3/4, smaller preoperative SL or PL, and an anterior position of the cage are likely to result in increased SL after MIS-TLIF.

Comparative Analysis of Open Transforaminal Lumbar Interbody Fusion and Wiltse Transforaminal Lumbar Interbody Fusion Approaches for Treating Single-Level Lumbar Spondylolisthesis: A Single-Center Retrospective Study

“…The results of this study confirm that the two techniques are equally effective in terms of clinical outcomes, including improvement in ODI values, VAS scores, and fusion rates. However, the Wiltse TLIF technique was found to be associated with a shorter time of surgery and less blood loss, while requiring more time for intraoperative imaging [21][22][23].…”

The Clinical Use of Osteobiologic and Metallic Biomaterials in Orthopedic Surgery: The Present and the Future

“…When using 3D-printed materials, the incidence of complications, such as cement leakage, was also reduced among patients who previously experienced surgical difficulties ( Figure 3 ) [ 73 , 140 ]. The shape and height of interbody cages are important for correcting the sagittal alignment in degenerative spine diseases, including in osteoporotic patients [ 141 ]. Therefore, the use of patient-specific interbody cages can result in a better surgical prognosis.…”

“…The shape and height of interbody cages are important for correcting the sagittal alignment in degenerative spine diseases, including in osteoporotic patients [141]. Therefore, the use of patient-specific interbody cages can result in a better surgical prognosis.…”