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Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
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Correlation Between Cage Positioning and Lumbar Lordosis in Transforaminal Lumbar Interbody Fusion (TLIF)
Emiliano Neves Vialle1, Guilherme Zandavalli Ramos1, Fabian Lopez Hinojosa2
1Grupo de Cirurgia da Coluna, Departamento de Ortopedia e Traumatologia, Hospital Universitário Cajuru, Curitiba, PR, Brasil.
Revista Brasileira De Ortopedia
|October 13, 2022
Summary
Anterior cage placement in transforaminal lumbar interbody fusion (TLIF) surgery significantly improves lumbar and segmental lordosis compared to posterior placement. This finding offers valuable insights for optimizing surgical techniques in spinal fusion procedures.
Area of Science:
- Orthopedic Surgery
- Spinal Fusion Techniques
- Radiographic Analysis
Background:
- Degenerative lumbar disease often necessitates spinal fusion to restore stability and alleviate pain.
- Transforaminal lumbar interbody fusion (TLIF) is a common surgical technique for achieving lumbar fusion.
- Optimizing interbody device placement is crucial for achieving favorable radiographic outcomes and spinal alignment.
Purpose of the Study:
- To evaluate the radiographic outcomes of transforaminal lumbar interbody fusion (TLIF).
- To compare the achieved lumbar lordosis based on the positioning of the interbody device (cage) within the disc space.
- To determine if anterior or posterior cage placement yields superior spinal alignment.
Main Methods:
- Retrospective radiographic analysis of 100 patients undergoing single-level TLIF with posterior pedicle instrumentation.
- Patients were categorized into two groups: TLIF-A (anterior cage placement) and TLIF-P (posterior cage placement).
- Pre- and postoperative lateral radiographs were used to measure lumbar lordosis (L1-S1), segmental lordosis (L4-S1), and segmental lordosis of the cage (SLC).
Main Results:
- The TLIF-A group (n=43) demonstrated significantly improved postoperative lumbar lordosis (50.7°) and segmental lordosis (34.9°) compared to the TLIF-P group (n=57) (LL: 42.3°, SL: 30.7°).
- While segmental lordosis of the cage (SLC) was higher in the TLIF-A group (21.6°) versus TLIF-P (18.8°), this difference was not statistically significant (p > 0.05).
- The study included patients aged 27-76 years, with a mean age of 50.5 years.
Conclusions:
- Anterior positioning of the interbody cage in TLIF procedures leads to improved radiographic lumbar and segmental lordosis.
- This finding suggests that optimizing cage placement anteriorly can enhance spinal alignment restoration after TLIF surgery.
- Surgeons may consider anterior cage placement to maximize lordotic correction in TLIF procedures.
