Does transforaminal lumbar interbody fusion induce lordosis or kyphosis? Radiographic evaluation with a minimum 2-year follow-up

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  • 1 Department of Neurological Surgery, University of California, San Francisco, California; and
  • | 2 Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
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OBJECTIVE

Conflicting reports exist about whether transforaminal lumbar interbody fusion (TLIF) induces lordosis or kyphosis, ranging from decreasing lordosis by 3.71° to increasing it by 18.8°. In this study, the authors’ aim was to identify factors that result in kyphosis or lordosis after TLIF.

METHODS

A single-center, retrospective study of open TLIF without osteotomy for spondylolisthesis with a minimum 2-year follow-up was undertaken. Preoperative and postoperative clinical and radiographic parameters and cage specifics were collected. TLIFs were considered to be “lordosing” if postoperative induction of lordosis was > 0° and “kyphosing” if postoperative induction of lordosis was ≤ 0°.

RESULTS

A total of 137 patients with an average follow-up of 52.5 months (range 24–130 months) were included. The overall postoperative disc angle (DA) and segmental lordosis (SL) increased by 1.96° and 1.88° (p = 0.003 and p = 0.038), respectively, whereas overall lumbar lordosis remained unchanged (p = 0.133). Seventy-nine patients had lordosing TLIFs with a mean SL increase of 5.72° ± 3.97°, and 58 patients had kyphosing TLIFs with a mean decrease of 3.02° ± 2.98°. Multivariate analysis showed that a lower preoperative DA, lower preoperative SL, and anterior cage placement were correlated with the greatest increase in postoperative SL (p = 0.040, p < 0.001, and p = 0.035, respectively). There was no difference in demographics, cage type or height, or spinopelvic parameters between the groups (p > 0.05). Linear regression showed that the preoperative DA and SL correlated with SL after TLIF (R2 = 0.198, p < 0.001; and R2 = 0.2931, p < 0.001, respectively).

CONCLUSIONS

Whether a TLIF induces kyphosis or lordosis depends on the preoperative DA, preoperative SL, and cage position. Less-lordotic segments became more lordotic postoperatively, and highly lordotic segments may lose lordosis after TLIF. Cages placed more anteriorly were associated with more lordosis.

ABBREVIATIONS

ASD = adjacent-segment disease; DA = disc angle; LL = lumbar lordosis; PGR = posterior gap ratio; PI = pelvic incidence; PI-LL = mismatch of PI and LL; PT = pelvic tilt; SL = segmental lordosis; SS = sacral slope; TLIF = transforaminal lumbar interbody fusion.

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Contributor Notes

Correspondence Jinping Liu: Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China. liujinpingsw@med.uestc.edu.cn.

INCLUDE WHEN CITING Published online July 9, 2021; DOI: 10.3171/2020.12.SPINE201665.

Disclosures Dr. Mummaneni: consultant for DePuy Synthes, Globus, and Stryker; direct stock ownership in Spinicity/ISD; royalties from DePuy Synthes, Thieme Publishing, and Springer Publishing; support of non–study-related clinical or research effort from AO Spine, NREF, and ISSG. Dr. Berven: ownership in Green Sun Medical; royalties from Stryker; and consultant for Medtronic, Innvasis, Globus, Stryker, and Integrity. Dr. Chou: consultant for and royalties from Globus.

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