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KMID : 0311120220630070665
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Yonsei Medical Journal
2022 Volume.63 No. 7 p.665 ~ p.674
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What Affects Segmental Lordosis of the Surgical Site after Minimally Invasive Transforaminal Lumbar Interbody Fusion?
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Kim Soo-Heon
Hahn Bang-Sang
Park Jeong-Yoon
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Abstract
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Purpose: This study was undertaken to identify factors that affect segmental lordosis (SL) after minimally invasive transforaminallumbar interbody fusion (MIS-TLIF) by comparing patients whose postoperative SL increased with those whose decreased.
Materials and Methods: Fifty-five patients underwent MIS-TLIF at our institute from January 2018 to September 2019. Demo graphic, pre- and postoperative radiologic, and cage-related factors were included. Statistical analyses were designed to comparepatients whose SL increased with decreased after surgery.
Results: After surgery, SL increased in 34 patients (group I) and decreased in 21 patients (group D). The index level, disc lordosis,SL, lumbar lordosis, proximal lordosis (PL), and Y-axis position of the cage (Yc) differed significantly between groups I and D. Thecage in group I was more anterior than that in group D (Yc: 55.84% vs. 51.24%). Multivariate analysis showed that SL decreasedmore significantly after MIS-TLIF when the index level was L3/4 rather than L4/5 [odds ratio (OR): 0.46, p=0.019], as preoperativeSL (OR: 0.82, p=0.037) or PL (OR: 0.68, p=0.028) increased, and as the cage became more posterior (OR: 1.10, p=0.032).
Conclusion: Changes in SL after MIS-TLIF appear to be associated with preoperative SL and PL, index level, and Yc. An index levelat L4/5 instead of L3/4, smaller preoperative SL or PL, and an anterior position of the cage are likely to result in increased SL afterMIS-TLIF.
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KEYWORD
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Minimally invasive, transforaminal lumbar interbody fusion, lumbar lordosis, cage, outcome, spine surgery, segmental lordosis
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