Preoperative Radiographic Prediction Tool for Early Postoperative Segmental and Lumbar Lordosis Alignment After Transforaminal Lumbar Interbody Fusion.

Ken Porche,Sasha Vaziri,Daniel J Hoh,Rachel Moor,Alexander Dru,Paul Kubilis

doi:10.7759/cureus.18175

Abstract

ObjectiveTransforaminal lumbar interbody fusion (TLIF) is a common approach and results in varying degrees of lordosis correction. The purpose of this study is to determine preoperative radiographic spinopelvic parameters that predict change in postoperative segmental and lumbar lordosis after TLIF.Materials & MethodsThis study is a single surgeon retrospective review of one-level and two-level TLIFs from L3-S1. All patients underwent bilateral facetectomies, 10 mm TLIF cage (non-lordotic) insertions, and bilateral pedicle screw-rod construct placements. Pre- and post-operative X-rays were assessed for preoperative segmental lordosis (SL), lumbar lordosis (LL), and pelvic incidence (PI). Univariate and multi-predictor linear regression analyses were performed to determine the relationships between preoperative radiographic findings and change in early postoperative segmental and lumbar lordosis.ResultsNinety-seven patients contributing 128 intervertebral segments were examined. The mean change in SL after TLIF was 7.3 (range: 0.10-28.9°, SD 6.39°). The mean change in LL after TLIF was 5.5˚ (range: -14.8-39.2°, standard deviation (SD) 7.16°). Greater preoperative LL predicted less postoperative LL correction, while greater preoperative PI predicted more postoperative SL and LL correction. Greater anterior disk height was noted to be associated with a decreased change in SL (∆SL). An annular tear on preoperative magnetic resonance imaging (MRI) predicted a 2.7° decrease in ∆SL. A Schmorl's node on preoperative MRI predicted a 4.0° decrease in change in LL (∆LL).ConclusionsA greater preoperative lordosis and a lower spinopelvic mismatch lessen the potential for an increase in the postoperative SL and LL after a TLIF, which is likely due to a ‘ceiling’ effect of an otherwise optimized spinal alignment. A greater anterior disk height and the presence of an annular tear are associated with decreased ∆SL.

Highlights

Transforaminal lumbar interbody fusion (TLIF) is a widely used, safe, and efficacious approach for surgical management of lumbar degenerative disease and spinal deformity [1,2,3,4]
Greater anterior disk height was noted to be associated with a decreased change in segmental lordosis (SL) (ΔSL)
A greater preoperative lordosis and a lower spinopelvic mismatch lessen the potential for an increase in the postoperative SL and lumbar lordosis (LL) after a TLIF, which is likely due to a ‘ceiling’ effect of an otherwise optimized spinal alignment

Summary

Introduction

Transforaminal lumbar interbody fusion (TLIF) is a widely used, safe, and efficacious approach for surgical management of lumbar degenerative disease and spinal deformity [1,2,3,4]. A unique potential advantage of lumbar interbody fusion is restoration of segmental lordosis (SL) and optimization of sagittal alignment [7,8,9,10,11]. When compared to stand-alone posterior fusion, the reduction of pelvic incidence (PI)-lumbar lordosis (LL) mismatch achieved with TLIF results in decreased adjacent segment disease, diminished need for revision surgery, and improved postoperative patient satisfaction [12, 13]. These widely range from 2.1 - 27.3 degrees, depending on

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