Comparison of Clinical and Radiographic Outcomes in Patients Receiving Single-Level Transforaminal Lumbar Interbody Fusion (TLIF) With Removal of Unilateral or Bilateral Facet Joints.
Spine (Phila Pa 1976). 2016 Feb 25;
Authors: Tye EY, Alentado VJ, Mroz TE, Orr RD, Steinmetz MP
STUDY DESIGN: Retrospective cohort study OBJECTIVE.: To compare the radiographic and clinical outcomes of transforaminal lumbar interbody fusion (TLIF) with bilateral facetectomy (BF) versus unilateral facetectomy (UF).
SUMMARY OF BACKGROUND DATA: Bilateral facetectomy is a surgical technique utilized with the intent of creating a greater degree of segmental lordosis compared to unilateral facetectomy alone. However, the clinical benefits of this technique have not been defined. We seek to determine whether a difference exists between bilateral versus unilateral facetectomy during TLIF by utilizing both clinical and radiographic outcome measures.
METHODS: The electronic medical records of 57 patients who underwent single-level TLIF with either a UF (n?=?28) or BF (n?=?29) were reviewed. Clinical outcomes were measured through Patient Health Questionnaire-9 (PHQ-9), Pain Disability Questionnaire (PDQ), EuroQol 5 Dimensions (EQ-5D) Health State, and Quality Adjusted Life Year (QALY). Radiographic parameters including disc height and sagittal balance were measured on plain radiographs at 1 year following operation.
RESULTS: All radiographic parameters showed no significant differences between the UF and BF cohorts. Segmental lordosis increased significantly in both cohorts. However, there was no significant difference in the increase of segmental lordosis between cohorts. Overall lumbar lordosis did not increase significantly in either cohort. Perioperative complications were also similar between cohorts. PDQ and EQ-5D scores improved significantly in both cohorts at 1 year postoperatively. The BF cohort showed a significantly greater improvement in both EQ-5D (0.1?±?0.2 vs. 0.3?±?0.2, p?=?0.01) and PHQ-9 scores (-0.8?±?4.6 vs. 4.6?±?5.2, p?=?0.03) compared to the UF cohort. The PDQ score improved over the minimally clinical important difference (MCID) of 26 in only the BF cohort.
CONCLUSIONS: The findings in the present study demonstrate that bilateral facetectomy during single-level TLIF improves clinical outcomes to a greater degree compared to unilateral facetectomy without any notable differences in perioperative complications or radiographic measurements.
LEVEL OF EVIDENCE: 3.
PMID: 26926356 [PubMed – as supplied by publisher]