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
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
KeywordsSagittal 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.
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 was obtained from all patients for being included in the study.
- 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):1459–1467Google Scholar
- 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. https://doi.org/10.1007/s00264-014-2516-6 Google Scholar
- 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. https://doi.org/10.1097/BRS.0000000000001535 Google Scholar
- 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. https://doi.org/10.1016/j.wneu.2017.09.154 Google Scholar
- 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. https://doi.org/10.1097/BRS.0b013e3181ee6bd4 Google Scholar
- 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):47–55Google Scholar
- 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):567–571Google Scholar
- 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. https://doi.org/10.1097/BRS.0000000000001857 Google Scholar
- 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):1693–1698Google Scholar
- 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):451–462Google Scholar
- 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. https://doi.org/10.1007/s00586-016-4424-5 Google Scholar