Impact of Single-Level Minimally Invasive Versus Open L4-L5 and L5-S1 Transforaminal Lumbar Interbody Fusion on Postoperative Distal and Lumbar Lordosis.

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2025-03-07 DOI:10.1097/BRS.0000000000005325

Takashi Hirase, Avani S Vaishnav, Joshua Zhang, Annika Bay, Eric T Kim, Mitchell S Fourman, Keith W Lyons, John C F Clohisy, Tomoyuki Asada, Hiroyuki Nakarai, Gregory S Kazarian, Kevin J DiSilvestro, Russel C Huang, Matthew E Cunningham, Sravisht Iyer, Todd J Albert, Han Jo Kim, Sheeraz A Qureshi

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引用次数: 0

Abstract

Study design: Retrospective cohort study.

Objective: To compare distal lordosis (DL) and lumbar lordosis (LL) generated by single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and open TLIF at L4-L5 and L5-S1.

Summary of background data: Restoring or maintaining L4-S1 DL and LL is an important component of TLIF surgery. However, the current literature is conflicting regarding the effect of surgical approach on these postoperative sagittal parameters.

Methods: Preoperative DL and LL were compared to postoperative values among adult patients undergoing single-level MI- and open TLIF surgeries. Subgroup analyses were performed with patients stratified based on pre-operative DL (low<25°, normal ≥ 25°), pelvic incidence (PI) (low<45°, moderate 45-60°, high > 60°), and PI-LL (high ≥ 10°, normal <10°). Regression analyses were conducted determining factors associated with postoperative DL and LL.

Results: Of the 285 patients included in the study, 211 underwent MI-TLIF (74.0%) and 74 (26.0%) underwent open TLIF. Patients with a high preoperative PI obtained a significant increase in LL at 6-month follow-up with an open TLIF (Δ4.2°, P=0.009) but not with an MI-TLIF (Δ-0.8°, P=0.151). Patients with a preoperative DL ≥ 25° experienced a decrease in DL at 6-month follow-up with both an open TLIF (Δ-2.0°, P=0.013) and MI-TLIF (Δ-1.4°, P=0.011). Patients with a preoperative DL ≥ 25° also experienced a decrease in LL at 6-month follow-up with an MI-TLIF (Δ-1.0°, P=0.002) but not with an open TLIF (Δ-0.3°, P=0.552). Patients with a preoperative DL<25° obtained an increase in both DL and LL with both MI-TLIF and open TLIF.

Conclusion: Both MI-TLIF and open TLIF are effective for improving DL and LL among patients with a low preoperative DL (<25°). However, patients with a high preoperative PI (>60°) may benefit from an open approach for a greater restoration and maintenance of LL.

Level of evidence: 3.

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单节段微创与开放L4-L5和L5-S1经椎间孔腰椎椎间融合术对术后远端腰椎前凸的影响。

研究设计：回顾性队列研究。目的：比较单节段微创经椎间孔腰椎椎间融合术（MI-TLIF）和开放TLIF在L4-L5和L5-S1处产生的远端前凸（DL）和腰椎前凸（LL）。背景资料总结：恢复或维持L4-S1 DL和LL是TLIF手术的重要组成部分。然而，关于手术入路对这些术后矢状面参数的影响，目前的文献是矛盾的。方法：将接受单节段心肌梗死和开放式TLIF手术的成年患者术前DL和LL与术后值进行比较。对患者进行亚组分析，根据术前DL（低60°）和PI-LL（高≥10°，正常）进行分层。结果：纳入研究的285例患者中，211例接受了MI-TLIF(74.0%)， 74例（26.0%）接受了open TLIF。术前PI高的患者在6个月的随访中，使用开放式TLIF （Δ4.2°，P=0.009）的LL显著增加，而使用MI-TLIF （Δ-0.8°，P=0.151）的LL没有显著增加。术前DL≥25°的患者在6个月的随访中，无论是开放式TLIF （Δ-2.0°，P=0.013）还是MI-TLIF （Δ-1.4°，P=0.011）， DL都有所下降。术前DL≥25°的患者在6个月的随访中，MI-TLIF （Δ-1.0°，P=0.002）也经历了LL的下降，但开放TLIF （Δ-0.3°，P=0.552）没有。结论：对于术前低深度DL（60°）的患者，MI-TLIF和开放TLIF均可有效改善DL和LL，开放入路可更好地恢复和维持LL。证据等级：3。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

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