Predictors of segmental lumbar lordosis following midline posterior (transforaminal) lumbar interbody fusion: Does interbody device type matter?
Background: Controversy exists regarding the ability of posterior (transforaminal) lumbar interbody fusion (PLIF/TLIF) to achieve lordosis. We hypothesized that an interbody device (IBD) designed for positioning in the anterior disc space produces greater lordosis than IBDs designed for straight-in...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-09-01
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| Series: | North American Spine Society Journal |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666548422000488 |
| _version_ | 1811269822162403328 |
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| author | Charles H Crawford, III Thomas N Epperson, IV Jeffrey L Gum R. Kirk Owens, II Mladen Djurasovic Steven D Glassman Leah Y Carreon |
| author_facet | Charles H Crawford, III Thomas N Epperson, IV Jeffrey L Gum R. Kirk Owens, II Mladen Djurasovic Steven D Glassman Leah Y Carreon |
| author_sort | Charles H Crawford, III |
| collection | DOAJ |
| description | Background: Controversy exists regarding the ability of posterior (transforaminal) lumbar interbody fusion (PLIF/TLIF) to achieve lordosis. We hypothesized that an interbody device (IBD) designed for positioning in the anterior disc space produces greater lordosis than IBDs designed for straight-in positioning. The purpose of this study is to determine if using either an anterior-position or straight-in position IBD design were associated with successful achievement of postoperative lordosis. Methods: A consecutive series of patients undergoing a undergoing a single-level, posterior open midline (transforaminal) lumbar interbody fusion procedure for degenerative spine conditions during a time period when the two types of interbody devices were being used at surgeon discretion were identified from a multi-surgeon academic training center. Patient demographics and radiographic measures including surgical level lordosis (SLL), anterior disc height, middle disc height, posterior disc height, IBD height, and IBD insertion depth were measured on preop, immediate postop, and one-year postop standing radiographs using PACS. Group comparison and regression analysis were performed using SPSS. Results: Sixty-one patients were included (n=37 anterior, n=34 straight-in). Mean age was 59.8±8.7 years, 32 (52%) were female. There was no difference between IBD type (anterior vs. straight-in) for mean Pre-op SLL (19±7° vs. 20±6°, p=0.7), Post-op SLL (21±5° vs 21±6°, p=0.5), or Change in SLL (2±4° vs. 1±5°, p=0.2). Regression analysis showed that Pre-op SLL was the only variable associated with Change in SLL (Beta = negative 0.48, p=0.000). While the mean Change in SLL could be considered clinically insignificant, there was wide variability: from a loss of 9° to a gain of 13°. Gain of lordosis >5° only occurred when Pre-op SLL was <21°, and loss of lordosis >5° only occurred when Pre-op SLL was >21°. Conclusions: While group averages showed an insignificant change in segmental lordosis following a posterior (transforaminal) interbody fusion regardless of interbody device type, pre-operative lordosis was correlated with a clinically significant change in segmental lordosis. Preoperative hypolordotic discs were more likely to gain significant lordosis, while preoperative hyperlordotic discs were more likely to lose significant lordosis. Surgeon awareness of this tendency can help guide surgical planning and technique. |
| first_indexed | 2024-04-12T21:50:01Z |
| format | Article |
| id | doaj.art-a4f84413772e492faada5195ba24fe95 |
| institution | Directory Open Access Journal |
| issn | 2666-5484 |
| language | English |
| last_indexed | 2024-04-12T21:50:01Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | North American Spine Society Journal |
| spelling | doaj.art-a4f84413772e492faada5195ba24fe952022-12-22T03:15:31ZengElsevierNorth American Spine Society Journal2666-54842022-09-0111100145Predictors of segmental lumbar lordosis following midline posterior (transforaminal) lumbar interbody fusion: Does interbody device type matter?Charles H Crawford, III0Thomas N Epperson, IV1Jeffrey L Gum2R. Kirk Owens, II3Mladen Djurasovic4Steven D Glassman5Leah Y Carreon6Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville KY, 40202, United States; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St., 1st Floor ACB, Louisville, KY 40202, United StatesDepartment of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St., 1st Floor ACB, Louisville, KY 40202, United StatesNorton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville KY, 40202, United States; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St., 1st Floor ACB, Louisville, KY 40202, United StatesNorton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville KY, 40202, United States; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St., 1st Floor ACB, Louisville, KY 40202, United StatesNorton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville KY, 40202, United States; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St., 1st Floor ACB, Louisville, KY 40202, United StatesNorton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville KY, 40202, United States; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St., 1st Floor ACB, Louisville, KY 40202, United StatesNorton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville KY, 40202, United States; Corresponding author at: Norton Leatherman Spine Center, 210 E Gray Street, Suite 900, Louisville, KY 40202, United States.Background: Controversy exists regarding the ability of posterior (transforaminal) lumbar interbody fusion (PLIF/TLIF) to achieve lordosis. We hypothesized that an interbody device (IBD) designed for positioning in the anterior disc space produces greater lordosis than IBDs designed for straight-in positioning. The purpose of this study is to determine if using either an anterior-position or straight-in position IBD design were associated with successful achievement of postoperative lordosis. Methods: A consecutive series of patients undergoing a undergoing a single-level, posterior open midline (transforaminal) lumbar interbody fusion procedure for degenerative spine conditions during a time period when the two types of interbody devices were being used at surgeon discretion were identified from a multi-surgeon academic training center. Patient demographics and radiographic measures including surgical level lordosis (SLL), anterior disc height, middle disc height, posterior disc height, IBD height, and IBD insertion depth were measured on preop, immediate postop, and one-year postop standing radiographs using PACS. Group comparison and regression analysis were performed using SPSS. Results: Sixty-one patients were included (n=37 anterior, n=34 straight-in). Mean age was 59.8±8.7 years, 32 (52%) were female. There was no difference between IBD type (anterior vs. straight-in) for mean Pre-op SLL (19±7° vs. 20±6°, p=0.7), Post-op SLL (21±5° vs 21±6°, p=0.5), or Change in SLL (2±4° vs. 1±5°, p=0.2). Regression analysis showed that Pre-op SLL was the only variable associated with Change in SLL (Beta = negative 0.48, p=0.000). While the mean Change in SLL could be considered clinically insignificant, there was wide variability: from a loss of 9° to a gain of 13°. Gain of lordosis >5° only occurred when Pre-op SLL was <21°, and loss of lordosis >5° only occurred when Pre-op SLL was >21°. Conclusions: While group averages showed an insignificant change in segmental lordosis following a posterior (transforaminal) interbody fusion regardless of interbody device type, pre-operative lordosis was correlated with a clinically significant change in segmental lordosis. Preoperative hypolordotic discs were more likely to gain significant lordosis, while preoperative hyperlordotic discs were more likely to lose significant lordosis. Surgeon awareness of this tendency can help guide surgical planning and technique.http://www.sciencedirect.com/science/article/pii/S2666548422000488Transforaminal interbody fusionTLIFInterbody deviceInterbody cageLumbar fusionLumbar lordosis |
| spellingShingle | Charles H Crawford, III Thomas N Epperson, IV Jeffrey L Gum R. Kirk Owens, II Mladen Djurasovic Steven D Glassman Leah Y Carreon Predictors of segmental lumbar lordosis following midline posterior (transforaminal) lumbar interbody fusion: Does interbody device type matter? North American Spine Society Journal Transforaminal interbody fusion TLIF Interbody device Interbody cage Lumbar fusion Lumbar lordosis |
| title | Predictors of segmental lumbar lordosis following midline posterior (transforaminal) lumbar interbody fusion: Does interbody device type matter? |
| title_full | Predictors of segmental lumbar lordosis following midline posterior (transforaminal) lumbar interbody fusion: Does interbody device type matter? |
| title_fullStr | Predictors of segmental lumbar lordosis following midline posterior (transforaminal) lumbar interbody fusion: Does interbody device type matter? |
| title_full_unstemmed | Predictors of segmental lumbar lordosis following midline posterior (transforaminal) lumbar interbody fusion: Does interbody device type matter? |
| title_short | Predictors of segmental lumbar lordosis following midline posterior (transforaminal) lumbar interbody fusion: Does interbody device type matter? |
| title_sort | predictors of segmental lumbar lordosis following midline posterior transforaminal lumbar interbody fusion does interbody device type matter |
| topic | Transforaminal interbody fusion TLIF Interbody device Interbody cage Lumbar fusion Lumbar lordosis |
| url | http://www.sciencedirect.com/science/article/pii/S2666548422000488 |
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