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Analysis of risk factors for contralateral symptomatic foraminal stenosis after unilateral transforaminal lumbar interbody fusion

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Abstract

Purpose

To analyze the risk factors of contralateral symptomatic foraminal stenosis (FS) after unilateral transforaminal lumbar interbody fusion (TLIF) and to guide and standardize the operation process of unilateral TLIF to reduce the occurrence of contralateral symptomatic FS.

Methods

A retrospective study was undertaken on 487 patients with lumbar degeneration who underwent unilateral TLIF in the Department of Spinal Surgery of Ningbo Sixth Hospital between January 2017 and January 2021, comprising 269 males and 218 females, with a mean age of 57.1 years (range, 48–77 years). Cases of intraoperative improper operations, such as screw deviation, postoperative hematoma, and contralateral disc herniation, were excluded, and cases of nerve root symptoms caused by contralateral FS were analyzed. Post-surgery, 23 patients with nerve root symptoms caused by contralateral FS were categorized as group A, and 60 patients without nerve root symptoms were randomly selected as group B during the same period. The general data (gender, age, body mass index (BMI), bone mineral density (BMD), and diagnosis) and imaging parameters before and after operation (including contralateral foramen area (CFA), lumbar lordosis angle (LL), segmental lordosis angle (SL), disc height (DH), foramen height (FH), foramen width (FW), fusion cage position, and the difference between postoperative and preoperative) were compared between the two groups. Univariate analysis was performed, and multivariate analysis was undertaken through logistics analysis to determine the independent risk factors. Additionally, the clinical outcomes of the two groups were compared immediately before surgery and one year after surgery, using the visual analogue scale (VAS) score and the Japanese Orthopaedic Association (JOA) score for evaluation.

Results

The patients in this study were followed up for a period of 19–25 (22.8atien months. Among them, 23 cases (4.72% incidence) were diagnosed with contralaterally symptomatic FS after the surgery. Univariate analysis indicated significant differences between the two groups in CFA, SL, FW, and cage coronal position. Logistic regression analysis identified preoperative contralateral foramen area (OR = 1.176, 95% CI (1.012, 1.367)), small segmental lordosis angle (OR = 2.225, 95% CI (1.124, 4.406)), small intervertebral foramen width (OR = 2.706, 95% CI (1.028, 7.118)), and cage coronal position not crossing the midline (OR = 1.567, 95% CI (1.142, 2.149)) as independent risk factors for contralateral symptomatic FS after unilateral TLIF. However, there was no statistically significant difference in the pain VAS score between the two groups one year after the operation. In contrast, there was a significant difference in the JOA score between the two groups.

Conclusion

The identified risk factors for contralateral symptomatic FS after TLIF include preoperative contralateral intervertebral foramen stenosis, a small segmental lordosis angle, a small intervertebral foramen width, and the coronal position of the cage not crossing the midline. For patients with these risk factors, it is recommended to carefully lock the screw rod during the recovery of lumbar lordosis and ensure that the coronal position of the fusion cage is implanted beyond the midline. If necessary, preventive decompression should also be considered. However, this study did not quantify the imaging data for each risk factor, and further research is needed to improve our understanding of the topic.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Authors and Affiliations

  1. Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China

    Wenjie Lu, Yuanguo Deng & Lingqiao Wu

  2. Huai’an Hospital of Traditional Chinese Medicine, Huaian, 223001, Jiangsu, China

    Jiaming Zhang

  3. Department of Spinal Surgery, Ningbo Sixth Hospital, Ningbo, 315040, Zhejiang, China

    Yunlin Chen, Xudong Hu, Chaoyue Ruan, Yang Wang, Weihu Ma & Weiyu Jiang

Authors
  1. Wenjie Lu
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  2. Jiaming Zhang
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  4. Lingqiao Wu
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  5. Yunlin Chen
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  6. Xudong Hu
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  7. Chaoyue Ruan
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  8. Yang Wang
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  9. Weihu Ma
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Contributions

All authors contributed to either data collection, analysis, or writing the manuscript. Wenjie Lu wrote the main manuscript text and finished the statistics of the article. Jiaming Zhang prepared the figures. Yuanguo Deng prepared the tables. Lingqiao Wu properly polished the manuscript. Yunlin Chen, Xudong Hu, Chaoyue Ruan, Yang Wang, and Weihu Ma all participated in the operation and collected relevant data. Weiyu Jiang reviewed and revised the manuscript. All authors reviewed the manuscript. The authors read and approved the final manuscript.

Corresponding author

Correspondence to Weiyu Jiang.

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Ethics approval

The study was approved by the Ethics Committee of Ningbo Sixth Hospital, and all methods were carried out in accordance with relevant guidelines and regulations. All patient-related data were approved for publication by the patients themselves or their guardians.

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Written informed consent was obtained from all the participants prior to the publication of this study.

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Lu, W., Zhang, J., Deng, Y. et al. Analysis of risk factors for contralateral symptomatic foraminal stenosis after unilateral transforaminal lumbar interbody fusion. International Orthopaedics (SICOT) 47, 1815–1826 (2023). https://doi.org/10.1007/s00264-023-05826-6

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