Related Experiment Video
Updated: May 20, 2025
Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
Achieving Greater Segmental Lordosis With Intraoperative Mechanical Hinging and Bilateral Facetectomies in Minimally
Rahul K Chaliparambil1, Mykhaylo Krushelnytskyy1, Amr J Alwakeal1
1Department of Neurological Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL.
Study Design:
Retrospective study.
Objective:
We add to the literature a series of transforaminal lumbar interbody fusion (TLIF) cases using a minimally invasive surgical [minimally invasive surgery (MIS)] approach with the use of a mechanically hinging operating table and bilateral facetectomies (Smith-Petersen osteotomy).
Background:
TLIF with interbody cages is understood to have a poor preservation of lordosis in the literature and can often be a kyphosing procedure. Intraoperative flexion using a hinged operating table to increase interbody spacing for cage placement, followed by intraoperative extension to facilitate osteotomy closure, may allow a greater degree of segmental lordosis (SL) to be achieved and maintained.
Materials And Methods:
We identified patients from 2018 to 2024 who underwent MIS-TLIF at our institution. Clinical and operative variables collected included age, sex, body mass index, hemoglobin A1C, smoking status, postsurgical Baastrup disease, indications for surgery, fusion level, and spacer details. Radiographic variables included SL at preoperative, intraoperative, and postoperative time points. Outcomes included postsurgical correction and 6-month correction. Clinical and radiographic findings were analyzed with standard statistical approaches.
Results:
Two hundred two patients met the inclusion criteria. For 1-level and 2-level fusion, the mean postsurgical correction was 5.0° and 4.6°, respectively, and the mean 6-month correction was 4.6° and 6.6°, respectively. Significant differences in lordosis were appreciated between preoperative and postoperative scans for both 1-level ( P < 0.0001) and 2-level ( P = 0.0017) fusion, and between preoperative and 6-month scans for 1-level ( P < 0.0001) fusion. Negative correlations were appreciated between preoperative and postoperative SL (R = -0.31, P = 0.0001) and preoperative SL and 6-month correction (R = -0.19, P = 0.0289) for 1-level fusions.
Conclusion:
The use of an intraoperative hinging surgical table during MIS-TLIF with bilateral Smith-Petersen osteotomies can effectively lead to an increase in and maintenance of SL.
