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Related Experiment Video

Updated: Jan 11, 2026

Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
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Sagittal Alignment Correction in Single-Level Minimally Invasive Transforaminal Interbody Fusion with Unilateral vs.

Sergej Telentschak1, Eva Fruechtl1, Moritz Perrech1

  • 1Department of General Neurosurgery, Centre of Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Str. 62, 50937 Köln, Germany.

Journal of Clinical Medicine
|November 13, 2025
PubMed
Summary

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Bilateral facetectomy (BF) offers no significant advantage over unilateral facetectomy (UF) in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for restoring lordosis or reducing spondylolisthesis. BF leads to increased blood loss and longer surgery times, suggesting selective use.

Area of Science:

  • Spine Surgery
  • Orthopedics
  • Minimally Invasive Procedures

Background:

  • Debate exists regarding the benefits of bilateral facetectomy (BF) versus unilateral facetectomy (UF) in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).
  • Limited evidence compares the impact of BF and UF on segmental lordosis, spondylolisthesis reduction, and neural foramina decompression.

Purpose of the Study:

  • To compare the radiographic and clinical outcomes of BF versus UF in patients undergoing single-level MI-TLIF.
  • To evaluate the specific benefits of contralateral facetectomy on segmental lordosis, spondylolisthesis, and disc height.

Main Methods:

  • Retrospective analysis of patients with lumbar degenerative disease undergoing single-level MI-TLIF with either UF or BF.
  • Radiographic assessment using plain radiographs, CT, and MRI.
Keywords:
bilateral facetectomy (BF)minimally invasive surgery (MIS)segmental lordosistransforaminal lumbar interbody fusion (TLIF)unilateral facetectomy (UF)

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  • Evaluation of intraoperative parameters including blood loss and surgical duration.

    • Main Results:

    • No significant difference was found in the increase of segmental lordosis between UF (2.1°) and BF (4.3°).
    • Spondylolisthesis reduction was comparable between groups (UF: 2.8 mm, BF: 2.4 mm).
    • Bilateral facetectomy resulted in significantly higher intraoperative blood loss (803 mL vs. 437 mL) and longer operative time (240 min vs. 197 min).

    Conclusions:

    • Bilateral facetectomy does not offer a substantial advantage over unilateral facetectomy in restoring segmental lordosis, spondylolisthesis, or posterior disc height in monosegmental MI-TLIF.
    • The increased surgical complexity, blood loss, and operative time associated with BF suggest its use should be reserved for specific indications.