Impact of Single-Level Minimally Invasive Versus Open L4-L5 and L5-S1 Transforaminal Lumbar Interbody Fusion on Postoperative Distal and Lumbar Lordosis

Takashi Hirase; Avani S. Vaishnav; Joshua Zhang; Annika Bay; Eric T. Kim; Mitchell S. Fourman; Keith W. Lyons; John C.F. Clohisy; Tomoyuki Asada; Hiroyuki Nakarai; Gregory S. Kazarian; Kevin J. Disilvestro; Russel C. Huang; Matthew E. Cunningham; Sravisht Iyer; Todd J. Albert; Han Jo Kim; Sheeraz A. Qureshi

doi:10.1097/BRS.0000000000005325

Impact of Single-Level Minimally Invasive Versus Open L4-L5 and L5-S1 Transforaminal Lumbar Interbody Fusion on Postoperative Distal and Lumbar Lordosis

Takashi Hirase, Avani S. Vaishnav, Joshua Zhang, Annika Bay, Eric T. Kim, Mitchell S. Fourman, Keith W. Lyons, John C.F. Clohisy, Tomoyuki Asada, Hiroyuki Nakarai, Gregory S. Kazarian, Kevin J. Disilvestro, Russel C. Huang, Matthew E. Cunningham, Sravisht Iyer, Todd J. Albert, Han Jo Kim, Sheeraz A. Qureshi

Division of Spine

Research output: Contribution to journal › Article › peer-review

Abstract

Study Design. Retrospective cohort study Objective. To compare distal lordosis (DL) and lumbar lordosis (LL) generated by single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and open TLIF at L4-L5 and L5-S1. Summary of Background Data. Restoring or maintaining L4-S1 DL and LL is an important component of TLIF surgery. However, the current literature is conflicting regarding the effect of surgical approach on these postoperative sagittal parameters. Methods. Preoperative DL and LL were compared to postoperative values among adult patients undergoing single-level MI- and open TLIF surgeries. Subgroup analyses were performed with patients stratified based on pre-operative DL (low<25°, normal ≥ 25°), pelvic incidence (PI) (low<45°, moderate 45-60°, high > 60°), and PI-LL (high ≥ 10°, normal <10°). Regression analyses were conducted determining factors associated with postoperative DL and LL. Results. Of the 285 patients included in the study, 211 underwent MI-TLIF (74.0%) and 74 (26.0%) underwent open TLIF. Patients with a high preoperative PI obtained a significant increase in LL at 6-month follow-up with an open TLIF (Δ4.2°, P=0.009) but not with an MI-TLIF (Δ-0.8°, P=0.151). Patients with a preoperative DL ≥ 25° experienced a decrease in DL at 6-month follow-up with both an open TLIF (Δ-2.0°, P=0.013) and MI-TLIF (Δ-1.4°, P=0.011). Patients with a preoperative DL ≥ 25° also experienced a decrease in LL at 6-month follow-up with an MI-TLIF (Δ-1.0°, P=0.002) but not with an open TLIF (Δ-0.3°, P=0.552). Patients with a preoperative DL<25° obtained an increase in both DL and LL with both MI-TLIF and open TLIF. Conclusion. Both MI-TLIF and open TLIF are effective for improving DL and LL among patients with a low preoperative DL (<25°). However, patients with a high preoperative PI (>60°) may benefit from an open approach for a greater restoration and maintenance of LL.

Original language	English
Journal	Spine
DOIs	https://doi.org/10.1097/BRS.0000000000005325
State	Accepted/In press - 2025

Keywords

lumbar lordosis
minimally invasive spine surgery
restoration
sagittal alignment
transforaminal lumbar interbody fusion

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10.1097/BRS.0000000000005325

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Hirase, T., Vaishnav, A. S., Zhang, J., Bay, A., Kim, E. T., Fourman, M. S., Lyons, K. W., Clohisy, J. C. F., Asada, T., Nakarai, H., Kazarian, G. S., Disilvestro, K. J., Huang, R. C., Cunningham, M. E., Iyer, S., Albert, T. J., Kim, H. J., & Qureshi, S. A. (Accepted/In press). Impact of Single-Level Minimally Invasive Versus Open L4-L5 and L5-S1 Transforaminal Lumbar Interbody Fusion on Postoperative Distal and Lumbar Lordosis. Spine. https://doi.org/10.1097/BRS.0000000000005325

@article{1a79e953d98f4498a9330d18b82e6fee,

title = "Impact of Single-Level Minimally Invasive Versus Open L4-L5 and L5-S1 Transforaminal Lumbar Interbody Fusion on Postoperative Distal and Lumbar Lordosis",

abstract = "Study Design. Retrospective cohort study Objective. To compare distal lordosis (DL) and lumbar lordosis (LL) generated by single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and open TLIF at L4-L5 and L5-S1. Summary of Background Data. Restoring or maintaining L4-S1 DL and LL is an important component of TLIF surgery. However, the current literature is conflicting regarding the effect of surgical approach on these postoperative sagittal parameters. Methods. Preoperative DL and LL were compared to postoperative values among adult patients undergoing single-level MI- and open TLIF surgeries. Subgroup analyses were performed with patients stratified based on pre-operative DL (low<25°, normal ≥ 25°), pelvic incidence (PI) (low<45°, moderate 45-60°, high > 60°), and PI-LL (high ≥ 10°, normal <10°). Regression analyses were conducted determining factors associated with postoperative DL and LL. Results. Of the 285 patients included in the study, 211 underwent MI-TLIF (74.0%) and 74 (26.0%) underwent open TLIF. Patients with a high preoperative PI obtained a significant increase in LL at 6-month follow-up with an open TLIF (Δ4.2°, P=0.009) but not with an MI-TLIF (Δ-0.8°, P=0.151). Patients with a preoperative DL ≥ 25° experienced a decrease in DL at 6-month follow-up with both an open TLIF (Δ-2.0°, P=0.013) and MI-TLIF (Δ-1.4°, P=0.011). Patients with a preoperative DL ≥ 25° also experienced a decrease in LL at 6-month follow-up with an MI-TLIF (Δ-1.0°, P=0.002) but not with an open TLIF (Δ-0.3°, P=0.552). Patients with a preoperative DL<25° obtained an increase in both DL and LL with both MI-TLIF and open TLIF. Conclusion. Both MI-TLIF and open TLIF are effective for improving DL and LL among patients with a low preoperative DL (<25°). However, patients with a high preoperative PI (>60°) may benefit from an open approach for a greater restoration and maintenance of LL.",

keywords = "lumbar lordosis, minimally invasive spine surgery, restoration, sagittal alignment, transforaminal lumbar interbody fusion",

author = "Takashi Hirase and Vaishnav, {Avani S.} and Joshua Zhang and Annika Bay and Kim, {Eric T.} and Fourman, {Mitchell S.} and Lyons, {Keith W.} and Clohisy, {John C.F.} and Tomoyuki Asada and Hiroyuki Nakarai and Kazarian, {Gregory S.} and Disilvestro, {Kevin J.} and Huang, {Russel C.} and Cunningham, {Matthew E.} and Sravisht Iyer and Albert, {Todd J.} and Kim, {Han Jo} and Qureshi, {Sheeraz A.}",

year = "2025",

doi = "10.1097/BRS.0000000000005325",

language = "English",

journal = "Spine",

issn = "0362-2436",

}

Hirase, T, Vaishnav, AS, Zhang, J, Bay, A, Kim, ET, Fourman, MS, Lyons, KW, Clohisy, JCF, Asada, T, Nakarai, H, Kazarian, GS, Disilvestro, KJ, Huang, RC, Cunningham, ME, Iyer, S, Albert, TJ, Kim, HJ & Qureshi, SA 2025, 'Impact of Single-Level Minimally Invasive Versus Open L4-L5 and L5-S1 Transforaminal Lumbar Interbody Fusion on Postoperative Distal and Lumbar Lordosis', Spine. https://doi.org/10.1097/BRS.0000000000005325

TY - JOUR

T1 - Impact of Single-Level Minimally Invasive Versus Open L4-L5 and L5-S1 Transforaminal Lumbar Interbody Fusion on Postoperative Distal and Lumbar Lordosis

AU - Hirase, Takashi

AU - Vaishnav, Avani S.

AU - Zhang, Joshua

AU - Bay, Annika

AU - Kim, Eric T.

AU - Fourman, Mitchell S.

AU - Lyons, Keith W.

AU - Clohisy, John C.F.

AU - Asada, Tomoyuki

AU - Nakarai, Hiroyuki

AU - Kazarian, Gregory S.

AU - Disilvestro, Kevin J.

AU - Huang, Russel C.

AU - Cunningham, Matthew E.

AU - Iyer, Sravisht

AU - Albert, Todd J.

AU - Kim, Han Jo

AU - Qureshi, Sheeraz A.

PY - 2025

Y1 - 2025

N2 - Study Design. Retrospective cohort study Objective. To compare distal lordosis (DL) and lumbar lordosis (LL) generated by single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and open TLIF at L4-L5 and L5-S1. Summary of Background Data. Restoring or maintaining L4-S1 DL and LL is an important component of TLIF surgery. However, the current literature is conflicting regarding the effect of surgical approach on these postoperative sagittal parameters. Methods. Preoperative DL and LL were compared to postoperative values among adult patients undergoing single-level MI- and open TLIF surgeries. Subgroup analyses were performed with patients stratified based on pre-operative DL (low<25°, normal ≥ 25°), pelvic incidence (PI) (low<45°, moderate 45-60°, high > 60°), and PI-LL (high ≥ 10°, normal <10°). Regression analyses were conducted determining factors associated with postoperative DL and LL. Results. Of the 285 patients included in the study, 211 underwent MI-TLIF (74.0%) and 74 (26.0%) underwent open TLIF. Patients with a high preoperative PI obtained a significant increase in LL at 6-month follow-up with an open TLIF (Δ4.2°, P=0.009) but not with an MI-TLIF (Δ-0.8°, P=0.151). Patients with a preoperative DL ≥ 25° experienced a decrease in DL at 6-month follow-up with both an open TLIF (Δ-2.0°, P=0.013) and MI-TLIF (Δ-1.4°, P=0.011). Patients with a preoperative DL ≥ 25° also experienced a decrease in LL at 6-month follow-up with an MI-TLIF (Δ-1.0°, P=0.002) but not with an open TLIF (Δ-0.3°, P=0.552). Patients with a preoperative DL<25° obtained an increase in both DL and LL with both MI-TLIF and open TLIF. Conclusion. Both MI-TLIF and open TLIF are effective for improving DL and LL among patients with a low preoperative DL (<25°). However, patients with a high preoperative PI (>60°) may benefit from an open approach for a greater restoration and maintenance of LL.

AB - Study Design. Retrospective cohort study Objective. To compare distal lordosis (DL) and lumbar lordosis (LL) generated by single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and open TLIF at L4-L5 and L5-S1. Summary of Background Data. Restoring or maintaining L4-S1 DL and LL is an important component of TLIF surgery. However, the current literature is conflicting regarding the effect of surgical approach on these postoperative sagittal parameters. Methods. Preoperative DL and LL were compared to postoperative values among adult patients undergoing single-level MI- and open TLIF surgeries. Subgroup analyses were performed with patients stratified based on pre-operative DL (low<25°, normal ≥ 25°), pelvic incidence (PI) (low<45°, moderate 45-60°, high > 60°), and PI-LL (high ≥ 10°, normal <10°). Regression analyses were conducted determining factors associated with postoperative DL and LL. Results. Of the 285 patients included in the study, 211 underwent MI-TLIF (74.0%) and 74 (26.0%) underwent open TLIF. Patients with a high preoperative PI obtained a significant increase in LL at 6-month follow-up with an open TLIF (Δ4.2°, P=0.009) but not with an MI-TLIF (Δ-0.8°, P=0.151). Patients with a preoperative DL ≥ 25° experienced a decrease in DL at 6-month follow-up with both an open TLIF (Δ-2.0°, P=0.013) and MI-TLIF (Δ-1.4°, P=0.011). Patients with a preoperative DL ≥ 25° also experienced a decrease in LL at 6-month follow-up with an MI-TLIF (Δ-1.0°, P=0.002) but not with an open TLIF (Δ-0.3°, P=0.552). Patients with a preoperative DL<25° obtained an increase in both DL and LL with both MI-TLIF and open TLIF. Conclusion. Both MI-TLIF and open TLIF are effective for improving DL and LL among patients with a low preoperative DL (<25°). However, patients with a high preoperative PI (>60°) may benefit from an open approach for a greater restoration and maintenance of LL.

KW - lumbar lordosis

KW - minimally invasive spine surgery

KW - restoration

KW - sagittal alignment

KW - transforaminal lumbar interbody fusion

UR - http://www.scopus.com/inward/record.url?scp=105002185093&partnerID=8YFLogxK

U2 - 10.1097/BRS.0000000000005325

DO - 10.1097/BRS.0000000000005325

M3 - Article

C2 - 40085161

AN - SCOPUS:105002185093

SN - 0362-2436

JO - Spine

JF - Spine

ER -

Impact of Single-Level Minimally Invasive Versus Open L4-L5 and L5-S1 Transforaminal Lumbar Interbody Fusion on Postoperative Distal and Lumbar Lordosis

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