European Spine Journal

, Volume 28, Issue 4, pp 745–750 | Cite as

Failure to maintain segmental lordosis during TLIF for one-level degenerative spondylolisthesis negatively affects clinical outcome 5 years postoperatively: a prospective cohort of 57 patients

  • Matevž Kuhta
  • Klemen Bošnjak
  • Rok VengustEmail author
Original Article



The present study aimed to determine whether obtaining adequate lumbar (LL) or segmental (SL) lordosis during instrumented TLIF for one-level degenerative spondylolisthesis affects midterm clinical outcome.


The study was designed as a prospective one, including 57 patients who underwent single-level TLIF surgery for degenerative spondylolisthesis. Patients were analyzed globally with additional subgroup analysis according to pelvic incidence (PI). Radiographic analysis of spinopelvic sagittal parameters was conducted pre- and postoperatively. Clinical examination including ODI score was performed preoperatively, 1 and 5 years postoperatively.


Significant improvement in ODI scores at 1 and 5 years postoperatively (p < 0.001) was demonstrated. There was a significant correlation between anterior shift of SVA and failure to improve SL (p = 0.046). Moreover, anterior SVA shift correlated with increased values of ODI score both 1 and 5 years postoperatively. In low-PI group, failure to correct LL correlated with high ODI scores 5 years postoperatively (r = − 0.499, p = 0.005).


Failure to correct segmental lordosis during surgery for one-level degenerative spondylolisthesis resulted in anterior displacement of the center of gravity, which in turn correlated with unfavorable clinical outcome 1 and 5 years postoperatively. In patients with low PI, failure to maintain lumbar lordosis correlated with unfavorable clinical outcome 5 years after surgery.

Level of evidence


Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Sagittal balance TLIF Degenerative spondylolisthesis Segmental lordosis Clinical outcomes 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical standards

All procedures were in accordance with ethical standards of the National ethics committee of Slovenia on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Informed consent was obtained from all patients for being included in the study.

Supplementary material

586_2019_5890_MOESM1_ESM.pptx (142 kb)
Supplementary material 1 (PPTX 141 kb)


  1. 1.
    Barrey C, Roussouly P, Le Huec JC, D’Acunzi G, Perrin G (2013) Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J 22(6):S834–S841. CrossRefPubMedGoogle Scholar
  2. 2.
    Barrey C, Jund J, Noseda O, Roussouly P (2007) Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J 16(9):1459–1467CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Barrey C, Darnis A (2015) Current strategies for the restoration of adequate lordosis during lumbar fusion. World J Orthop 6(1):117–126. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Le Huec JC, Faundez A, Dominguez D, Hoffmeyer P, Aunoble S (2015) Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review. Int Orthop 39(1):87–95. CrossRefPubMedGoogle Scholar
  5. 5.
    Tye EY, Alentado VJ, Mroz TE, Orr RD, Steinmetz MP (2016) Comparison of clinical and radiographic outcomes in patients receiving single-level transforaminal lumbar interbody fusion with removal of unilateral or bilateral facet joints. Spine (Phila Pa 1976) 41(17):E1039–E1045. CrossRefGoogle Scholar
  6. 6.
    Cheng X, Zhang F, Zhang K, Sun X, Zhao C, Li H, Li YM, Zhao J (2017) Effect of single-level transforaminal lumbar interbody fusion on segmental and overall lumbar lordosis in patients with lumbar degenerative disease. World Neurosurg 109:e244–e251. CrossRefPubMedGoogle Scholar
  7. 7.
    Schwab F, Patel A, Ungar B, Farcy JP, Lafage V (2010) Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? an overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976) 35(25):2224–2231. CrossRefGoogle Scholar
  8. 8.
    Lazennec JY, Ramaré S, Arafati N, Laudet CG, Gorin M, Roger B, Hansen S, Saillant G, Maurs L, Trabelsi R (2000) Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J 9(1):47–55CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Humphreys SC, Hodges SD, Patwardhan AG, Eck JC, Murphy RB, Covington LA (2001) Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine (Phila Pa 1976) 26(5):567–571CrossRefGoogle Scholar
  10. 10.
    Challier V, Boissiere L, Obeid I, Vital JM, Castelain JE, Bénard A, Ong N, Ghailane S, Pointillart V, Mazas S, Mariey R, Gille O (2017) One-level lumbar degenerative spondylolisthesis and posterior approach: is transforaminal lateral interbody fusion mandatory? a randomized controlled trial with 2-year follow-up. Spine (Phila Pa 1976) 42(8):531–539. CrossRefGoogle Scholar
  11. 11.
    Galla F, Wähnert D, Liljenqvist U (2018) Georg Schmorl Prize of the German Spine Society (DWG) 2017: correction of spino-pelvic alignment with relordosing mono- and bisegmental TLIF spondylodesis. Eur Spine J 27(4):789–796. CrossRefPubMedGoogle Scholar
  12. 12.
    Liang Y, Shi W, Jiang C, Chen Z, Liu F, Feng Z, Jiang X (2015) Clinical outcomes and sagittal alignment of single-level unilateral instrumented transforaminal lumbar interbody fusion with a 4 to 5-year follow-up. Eur Spine J 24(11):2560–2566. CrossRefPubMedGoogle Scholar
  13. 13.
    Lauber S, Schulte TL, Liljenqvist U, Halm H, Hackenberg L (2006) Clinical and radiologic 2–4-year results of transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Spine (Phila Pa 1976) 31(15):1693–1698CrossRefGoogle Scholar
  14. 14.
    Morvan G, Mathieu P, Vuillemin V, Guerini H, Bossard P, Zeitoun F, Wybier M (2011) Standardized way for imaging of the sagittal spinal balance. Eur Spine J 20(5):602–608. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Duval-Beaupère G, Schmidt C, Cosson P (1992) A barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng 20(4):451–462CrossRefPubMedGoogle Scholar
  16. 16.
    Schwab F, Lafage V, Patel A, Farcy JP (2009) Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976) 34(17):1828–1833. CrossRefGoogle Scholar
  17. 17.
    Le Huec JC, Charosky S, Barrey C, Rigal J, Aunoble S (2011) Sagittal imbalance cascade for simple degenerative spine and consequences: algorithm of decision for appropriate treatment. Eur Spine J 20(5):699–703. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Cogniet A, Aunoble S, Rigal J, Demezon H, Sadikki R, Le Huec JC (2016) Clinical and radiological outcomes of lumbar posterior subtraction osteotomies are correlated to pelvic incidence and FBI index: prospective series of 63 cases. Eur Spine J 25(8):2657–2667. CrossRefPubMedGoogle Scholar
  19. 19.
    Ould-Slimane M, Lenoir T, Dauzac C, Rillardon L, Hoffmann E, Guigui P, Ilharreborde B (2012) Influence of transforaminal lumbar interbody fusion procedures on spinal and pelvic parameters of sagittal balance. Eur Spine J 21(6):1200–1206. CrossRefPubMedGoogle Scholar
  20. 20.
    Rice JW, Sedney CL, Daffner SD, Arner JW, Emery SE, France JC (2013) Improvement of segmental lordosis in transforaminal lumbar interbody fusion: a comparison of two techniques. Glob Spine J 6(3):229–233. CrossRefGoogle Scholar
  21. 21.
    Recnik G, Košak R, Vengust R (2013) Influencing segmental balance in isthmic spondylolisthesis using transforaminal lumbar interbody fusion. J Spinal Disord Tech 26(5):246–251. CrossRefPubMedGoogle Scholar
  22. 22.
    Schroerlucke SR, Steklov N, Mundis GM Jr, Marino JF, Akbarnia BA, Eastlack RK (2014) How does a novel monoplanar pedicle screw perform biomechanically relative to monoaxial and polyaxial designs? Clin Orthop Relat Res 472(9):2826–2832. CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Amabile C, Le Huec JC, Skalli W (2016) Invariance of head-pelvis alignment and compensatory mechanisms for asymptomatic adults older than 49 years. Eur Spine J 27(2):458–466. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryUniversity Clinical Centre MariborMariborSlovenia
  2. 2.Department of Orthopedic SurgeryLjubljana University Medical CentreLjubljanaSlovenia

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