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Preoperative lordosis in L4/5 predicts segmental lordosis correction achievable by transforaminal lumbar interbody fusion

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Abstract

Purpose

The mean potential of lordosis restoration by transforaminal lumbar interbody fusion (TLIF) is supposed to be low in general. In contrast, clinical experience shows a wide range of segmental lordosis correction. In this study, the predictability of lordosis correction should be investigated.

Methods

Prospectively collected register data were analyzed retrospectively. One hundred twenty-one consecutive patients (2014–2016) operated with single-level TLIF L4/5 (10°-lordotic cage). Segmental lordosis (L4/5) and overall lordosis (L1–S1) were measured on lumbar X-rays: preoperatively (pre), after 3–5 days (post), at least 24 months postoperatively (2yFU). Outcome and satisfaction of patients were assessed. Parameters were statistically compared by students t-tests (a = 0.05). In addition, predictors of correction were analyzed.

Results

Age was 60.7 years, rate of 2yFU 41.3% (n = 50). Lordosis correction L4/5 was statistically significant with (post–pre) 4.9 ± 5.7° (p < 0.01), but not significant for L1–S1 (post–pre) 1.6 ± 8.0° (p = 0.3). A strong–moderate correlation of lordosis L4/5 (pre) and lordosis correction L4/5 (post–pre) was shown (r =  − 0.6, p < 0,01). In a rising range of preoperative lordosis L4/5 from 15–30° the likelihood of lordosis loss increased. In 2yFU correction, L4/5 was significant with (post–pre) 5.4 ± 5.4° (p < 0.01), no significant long-term change (2yFU-postop)  − 1.5 ± 4.9° (p = 0.2). No correlation (r =  − 0.1) of correction and ODI. VAS-B improved by means of 2.9, VAS-L by 2.5, ODI by 19.1% (pre vs. 2yFU), each statistically significant (p < 0.01).

Conclusion

Significant segmental relordosation can be performed by TLIF L4/5. The potential of correction strongly correlates with preoperative lordosis. Therefore, TLIF technique should be considered carefully in cases with a preoperative segmental lordosis of more than 15° and additional need of lordosation.

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Authors and Affiliations

  1. Spine Surgery With Scoliosis Center, Schön Klinik Neustadt, Am Kiebitzberg 10, 23552, Neustadt in Holstein, Germany

    Clara Berlin, Ferdinand Zang, Henry Halm & Markus Quante

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  1. Clara Berlin
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  2. Ferdinand Zang
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Correspondence to Clara Berlin.

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Berlin, C., Zang, F., Halm, H. et al. Preoperative lordosis in L4/5 predicts segmental lordosis correction achievable by transforaminal lumbar interbody fusion. Eur Spine J 30, 1277–1284 (2021). https://doi.org/10.1007/s00586-020-06710-2

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  • DOI: https://doi.org/10.1007/s00586-020-06710-2

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