Indirect Effects on Adjacent Segments After Minimally Invasive Transforaminal Lumbar Interbody Fusion

Abstract

To compare radiographic parameters at adjacent segments before and after minimally invasive transforaminal lumbar interbody fusion and assess relationships of radiographic changes between adjacent segments and fused level. Study participants included 44 patients who underwent minimally invasive transforaminal lumbar interbody fusion at L4-5 level. Radiographic parameters at adjacent segments (L3-4 and L5-S1) and clinical parameters were reviewed. Postoperative dural sac area significantly increased in upper (mean change 8.05 mm2, P < 0.001) and lower (14.08 mm2, P < 0.001) adjacent segments. Significant increases in SAPD were seen in upper (0.85 mm, P < 0.001) and lower (0.66 mm, P < 0.001) adjacent segments. Ligamentum flavum thickness significantly decreased in lower adjacent segments (-0.37 mm, P= 0.006). For every 1-mm increase in fused level disc height, lower SAPD increased 0.22 mm (P= 0.04), and lower segmental angle increased 0.91° (P= 0.04). For every 1° increase in fused level segmental angle, lower dural sac area increased 1.25 mm2 (P= 0.03), and lower SAPD increased 0.12 mm (P= 0.003). The 6- and 12-month postoperative visual analog scale back and leg scores significantly decreased compared with preoperatively (back: mean change-5.98 and-6.05, P < 0.001; leg:-6.86 and-6.89, P < 0.001). Performing minimally invasive transforaminal lumbar interbody fusion at the symptomatic index level does not worsen canal dimension of asymptomatic adjacent segments during short-term follow-up. It might be possible to improve canal dimension at adjacent segments by changing disc height or lordosis at the fused level via adjusting size and position of the interbody cage.