Do intraoperative radiographs predict closing lumbar sagittal alignment following single-level transforaminal lumbar interbody fusion?
J Neurosurg Backbone. 2018 Feb 16;:1-6
Authors: Salem KMI, Eranki AP, Paquette S, Boyd M, Avenue J, Kwon BK, Fisher CG, Dvorak MF
OBJECTIVE The examine aimed to find out if the intraoperative segmental lordosis (as calculated on a cross-table lateral radiograph following a single-level transforaminal lumbar interbody fusion [TLIF] for degenerative spondylolisthesis/low-grade isthmic spondylolisthesis) is maintained at discharge and at 6 months postsurgery. METHODS The authors reviewed photos and medical data of sufferers ? 16 years of age with a analysis of an remoted single-level, low-grade spondylolisthesis (degenerative or isthmic) with symptomatic spinal stenosis handled between January 2008 and April 2014. Age, intercourse, surgical stage, surgical strategy, and facetectomy (unilateral vs bilateral) had been recorded. Upright standardized preoperative, early, and 6-month postoperative radiographs, in addition to intraoperative lateral radiographs, had been analyzed for the pelvic incidence, segmental lumbar lordosis (SLL) on the TILF stage, and whole LL (TLL). As well as, the anteroposterior place of the cage within the disc area was documented. Information are introduced because the imply ± SD; a p worth < zero.05 was thought-about vital. RESULTS Eighty-four sufferers had been included within the examine. The imply age of sufferers was 56.eight ± 13.7 years, and 46 sufferers (55%) had been males. The imply pelvic incidence was 59.7° ± 11.9°, and a posterior midline strategy was utilized in 47 instances (56%). All TLIF procedures had been single stage utilizing a bullet-shaped cage. A bilateral facetectomy was carried out in 17 sufferers (20.2%), and 89.three% of procedures had been finished on the L4-5 and L5-S1 segments. SLL considerably improved intraoperatively from 15.eight° ± 7.5° to 20.9° ± 7.7°, however the correction was misplaced after ambulation. In contrast with preoperative values, at 6 months the change in SLL was modest at 1.eight° ± 6.7° (p = zero.025), whereas TLL elevated by four.three° ± 9.6° (p < zero.001). The anteroposterior place of the cage, strategy, stage of surgical procedure, and use of a bilateral facetectomy didn’t considerably have an effect on postoperative LL. CONCLUSIONS Following a single-level TLIF process utilizing a bullet-shaped cage, the intraoperative enchancment in SLL is basically misplaced after ambulation. The advance in TLL over time might be because of the decompression a part of the process. The strategy, stage of surgical procedure, bilateral facetectomy, and place of the cage don’t appear to have a major impact on LL achieved postoperatively.
PMID: 29451437 [PubMed – as supplied by publisher]