TY - JOUR
T1 - Predictors of Postoperative Segmental and Overall Lumbar Lordosis in Minimally Invasive Transforaminal Lumbar Interbody Fusion
T2 - A Consecutive Case Series
AU - Zhang, Justin K.
AU - Greenberg, Jacob K.
AU - Javeed, Saad
AU - Benedict, Braeden
AU - Botterbush, Kathleen S.
AU - Dibble, Christopher F.
AU - Khalifeh, Jawad M.
AU - Brehm, Samuel
AU - Jain, Deeptee
AU - Dorward, Ian
AU - Santiago, Paul
AU - Molina, Camilo
AU - Pennicooke, Brenton H.
AU - Ray, Wilson Z.
N1 - Publisher Copyright:
© The Author(s) 2023.
PY - 2025/3
Y1 - 2025/3
N2 - Study Design: Retrospective Case-Series. Objectives: Due to heterogeneity in previous studies, the effect of MI-TLIF on postoperative segmental lordosis (SL) and lumbar lordosis (LL) remains unclear. Therefore, we aim to identify radiographic factors associated with lordosis after surgery in a homogenous series of MI-TLIF patients. Methods: A single-center retrospective review identified consecutive patients who underwent single-level MI-TLIF for grade 1 degenerative spondylolisthesis from 2015-2020. All surgeries underwent unilateral facetectomies and a contralateral facet release with expandable interbody cages. PROs included the ODI and NRS-BP for low-back pain. Radiographic measures included SL, disc height, percent spondylolisthesis, cage positioning, LL, PI-LL mismatch, sacral-slope, and pelvic-tilt. Surgeries were considered “lordosing” if the change in postoperative SL was ≥ +4° and “kyphosing” if ≤ -4°. Predictors of change in SL/LL were evaluated using Pearson’s correlation and multivariable regression. Results: A total of 73 patients with an average follow-up of 22.5 (range 12-61) months were included. Patients experienced significant improvements in ODI (29% ± 22% improvement, P <.001) and NRS-BP (3.3 ± 3 point improvement, P <.001). There was a significant increase in mean SL (Δ3.43° ± 4.37°, P <.001) while LL (Δ0.17° ± 6.98°, P >.05) remained stable. Thirty-eight (52%) patients experienced lordosing MI-TLIFs, compared to 4 (5%) kyphosing and 31 (43%) neutral MI-TLIFs. A lower preoperative SL and more anterior cage placement were associated with the greatest improvement in SL (β = -.45° P =.001, β = 15.06° P <.001, respectively). Conclusions: In our series, the majority of patients experienced lordosing or neutral MI-TLIFs (n = 69, 95%). Preoperative radiographic alignment and anterior cage placement were significantly associated with target SL following MI-TLIF.
AB - Study Design: Retrospective Case-Series. Objectives: Due to heterogeneity in previous studies, the effect of MI-TLIF on postoperative segmental lordosis (SL) and lumbar lordosis (LL) remains unclear. Therefore, we aim to identify radiographic factors associated with lordosis after surgery in a homogenous series of MI-TLIF patients. Methods: A single-center retrospective review identified consecutive patients who underwent single-level MI-TLIF for grade 1 degenerative spondylolisthesis from 2015-2020. All surgeries underwent unilateral facetectomies and a contralateral facet release with expandable interbody cages. PROs included the ODI and NRS-BP for low-back pain. Radiographic measures included SL, disc height, percent spondylolisthesis, cage positioning, LL, PI-LL mismatch, sacral-slope, and pelvic-tilt. Surgeries were considered “lordosing” if the change in postoperative SL was ≥ +4° and “kyphosing” if ≤ -4°. Predictors of change in SL/LL were evaluated using Pearson’s correlation and multivariable regression. Results: A total of 73 patients with an average follow-up of 22.5 (range 12-61) months were included. Patients experienced significant improvements in ODI (29% ± 22% improvement, P <.001) and NRS-BP (3.3 ± 3 point improvement, P <.001). There was a significant increase in mean SL (Δ3.43° ± 4.37°, P <.001) while LL (Δ0.17° ± 6.98°, P >.05) remained stable. Thirty-eight (52%) patients experienced lordosing MI-TLIFs, compared to 4 (5%) kyphosing and 31 (43%) neutral MI-TLIFs. A lower preoperative SL and more anterior cage placement were associated with the greatest improvement in SL (β = -.45° P =.001, β = 15.06° P <.001, respectively). Conclusions: In our series, the majority of patients experienced lordosing or neutral MI-TLIFs (n = 69, 95%). Preoperative radiographic alignment and anterior cage placement were significantly associated with target SL following MI-TLIF.
KW - lumbar lordosis
KW - minimally invasive
KW - segmental lordosis
KW - spondylolisthesis
KW - transforaminal lumbar interbody fusion
KW - transforaminal lumbar interbody fusion
UR - https://www.scopus.com/pages/publications/105001644392
U2 - 10.1177/21925682231193610
DO - 10.1177/21925682231193610
M3 - Article
C2 - 37522797
AN - SCOPUS:105001644392
SN - 2192-5682
VL - 15
SP - 425
EP - 437
JO - Global Spine Journal
JF - Global Spine Journal
IS - 2
ER -