Clinical and Short-Term Radiographic Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion With Expandable Lordotic Devices.

Abstract:

BACKGROUND:Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a well-accepted procedure for the treatment of degenerative lumbar disease. However, its ability to restore lumbar lordosis has been limited. Development of expandable lordotic interbody devices has challenged this limitation, furthering the scope of minimally invasive surgery. OBJECTIVE:To evaluate the radiographic and clinical effects of expandable lordotic interbody devices placed through an MIS-TLIF approach. METHODS:We conducted a retrospective review of 32 1-level and 18 2-level MIS-TLIFs performed using lordotic expandable interbody devices. Lumbar radiographic measurements, Oswestry Disability Index scores (ODI), and Visual Analogue Scale scores (VAS) were obtained at preoperative, 6 wk follow up, and last follow up time points. Last follow up occurred at a mean of 11.5 ± 7.6 mo (mean ± SD). RESULTS:At 6-wk follow-up, segmental lordosis, disc height, and foraminal height increased by an average of 3.4°, 6.4 mm, and 4.4 mm, respectively. Only the 2-level group showed a significant increase in lumbar lordosis of 5.8°. No significant changes occurred in sacral slope, pelvic tilt, or pelvic incidence. Average ODI and VAS decreased by -12.0 and -4.5, respectively. Postoperative lumbar lordosis inversely correlated with preoperative lordosis in patients with an initial Pelvic Incidence to Lumbar Lordosis mismatch (PI-LL) of >10°, (r = -0.5, P = .009). CONCLUSION:When applied across 2-levels, MIS-TLIF using expandable lordotic interbody devices produced a significant increase in lumbar lordosis. Preoperative lumbar lordosis was found to be a predictor of postoperative lumbar lordotic change in patients with sagittal imbalance.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

McMordie JH,Schmidt KP,Gard AP,Gillis CC

doi

10.1093/neuros/nyz402

subject

Has Abstract

pub_date

2020-02-01 00:00:00

pages

E147-E155

issue

2

eissn

0148-396X

issn

1524-4040

pii

5580875

journal_volume

86

pub_type

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