Segmental lumbar sagittal correction after bilateral transforaminal lumbar interbody fusion

Clinical article

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Object

In this paper the authors sought to determine the segmental lumbar sagittal contour change after bilateral transforaminal lumbar interbody fusion (TLIF).

Methods

Between March 2007 and October 2010, 42 consecutive patients (57 levels) underwent bilateral TLIF. Standard preoperative and 6-week postoperative standing lumbar spine radiographs were examined. Preoperative and postoperative segmental lordosis was determined by manual measurements using the Cobb method. The difference between the preoperative and postoperative values were calculated and analyzed for statistical significance.

Results

The mean preoperative segmental alignment was 8.1°. The mean postoperative alignment was 15.3°, with a mean correction of 7.2° per segment. The largest gain in lordosis was obtained at the L5–S1 level (10.1°). There was a significant difference between the preoperative and postoperative values (p = 5 × 10−9). There was no significant difference in mean segmental correction between levels. Improvement in lordosis was higher in multilevel fusions (9.8°) than in single-level fusions (5.2°) (p = 0.047). There was an inverse correlation between preoperative sagittal lordosis measurement and change in lordosis (r = −0.599).

Conclusions

A significant improvement in lumbar lordosis can be gained by preforming bilateral facetectomies in TLIF with posterior compression. This procedure provides an additional option to a spine surgeon's armamentarium in dealing with significant lumbar sagittal plane deformities.

Abbreviations used in this paper:ALIF = anterior lumbar interbody fusion; TLIF = transforaminal lumbar interbody fusion.

Article Information

Address correspondence to: Sharon C. Yson, M.D., Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue, R200, Minneapolis, Minnesota 55454. email: scyson@umn.edu.

Please include this information when citing this paper: published online May 11, 2012; DOI: 10.3171/2012.4.SPINE111013.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Preoperative (A) and postoperative (B) radiographs obtained at 6 weeks.

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    Lateral radiographs of the lumbosacral spine showing the preoperative (A) and postoperative (B) foraminal size. Removal of bilateral facets allows for greater compression without compromising foraminal patency.

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    A greater degree of lumbar lordosis is attained after bilateral TLIF (A) than after Smith-Petersen osteotomy (B) because the interbody cage acts as an anterior pivot. Printed with permission from Sharon C. Yson, M.D.

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