Influence of local lordosing transforaminal lumbar interbody fusion on adjacent segments and spino-pelvic relationships. Radiographic study

Aleinik A.I., Mliavykh S.G., Bokov A.E., Taramzhenin M.V.

Abstract


Introduction
Until now, the rates of poor results of lumbar spinal fusion remain high. It is associated with the development of adjacent segment disease and spinopelvic imbalance. The use of lordosing transforaminal lumbar interbody fusion (cTLIF) is aimed at normalizing the sagittal profile of the operated and adjacent segments.
The purpose of this study was to evaluate changes in radiological segmental parameters at the level of spinal fusion, as well as their influence on adjacent segments and spinopelvic relationships.
Methods
The study included 30 patients who underwent 1- or 2-level lumbar fusion using the cTLIF technique. Radiography of the lumbar spine with hip joints prior to surgery and in the early postoperative period was used in all patients. The measurements of sagittal parameters at the level of intervention, in adjacent segments, as well as of spinopelvic relations were made.
Results
Segmental lordosis before the surgery was 4.85 ± 8.021° (-11° to 20°), and 12.58 ± 6.031° (4° to 25°) after it, p less 0.0001; average segmental correction was 8.35 ± 6.64°. Lumbar lordosis increased from 44.97 ± 17.58° to 51.8 ± 11.61°, p = 0.01; negative correlation was found between the correction value of lumbar lordosis and the initial lordosis (r = -0.7510, p = 0.0001). There was a significant decrease in lordosis in the adjacent segment from 8.77 ± 4.57° to 6.83 ± 3.96°, p = 0.015. Spino-pelvic relations improved (PI-LL before the operation was 13.1 ± 11.022° and 7.93 ± 5.97, p = 0.018 after it). There were no significant changes in the pelvic tilt (20.9 ± 7.18° versus 19.1 ± 8.58°, p = 0.13).
Conclusions
cTLIF provides correction of segmental lordosis by 8° on average. In the adjacent segment, there is a significant decrease in the severity of lordosis. Improvement of spinopelvic relations is achieved due to the normalization of the lumbar lordosis pro rata to the pelvic incidence. The use of cTLIF technique does not correct the angle of the pelvic tilt.

Keywords


lumbar spine, lumbar fusion, TLIF, spinopelvic relations, adjacent segment disease, sagittal balance

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