Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Nov 15;43(22):E1350-E1357.
doi: 10.1097/BRS.0000000000002705.

Lordosis Recreation in Transforaminal and Posterior Lumbar Interbody Fusion: A Cadaveric Study of the Influence of Surgical Bone Resection and Cage Angle

Peter A Robertson  1 , William A Armstrong  2 , Daniel L Woods  2 , Jeremy J Rawlinson  2
Affiliations

Lordosis Recreation in Transforaminal and Posterior Lumbar Interbody Fusion: A Cadaveric Study of the Influence of Surgical Bone Resection and Cage Angle

Peter A Robertson et al. Spine (Phila Pa 1976). .

Abstract

Study design: Controlled cadaveric study of surgical technique in transforaminal and posterior lumbar interbody fusion (TLIF and PLIF) OBJECTIVE.: To evaluate the contribution of surgical techniques and cage variables in lordosis recreation in posterior interbody fusion (TLIF/PLIF).

Summary of background data: The major contributors to lumbar lordosis are the lordotic lower lumbar discs. The pathologies requiring treatment with segmental fusion are frequently hypolordotic or kyphotic. Current posterior based interbody techniques have a poor track record for recreating lordosis, although recreation of lordosis with optimum anatomical alignment is associated with better outcomes and reduced adjacent segment change needing revision. It is unclear whether surgical techniques or cage parameters contribute significantly to lordosis recreation.

Methods: Eight instrumented cadaveric motion segments were evaluated with pre and post experimental radiological assessment of lordosis. Each motion segment was instrumented with pedicle screw fixation to allow segmental stabilization. The surgical procedures were unilateral TLIF with an 18° lordotic and 27 mm length cage, unilateral TLIF (18°, 27 mm) with bilateral facetectomy, unilateral TLIF (18°, 27 mm) with posterior column osteotomy (PCO), PLIF with bilateral cages (18°, 22 mm), and PLIF with bilateral cages (24°, 22 mm). Cage insertion used and "insert and rotate" technique.

Results: Pooled results demonstrated a mean increase in lordosis of 2.2° with each procedural step (lordosis increase was serially 1.8°, 3.5°, 1.6°, 2.5°, and 1.6° through the procedures). TLIF and PLIF with PCO increased lordosis significantly compared with unilateral TLIF and TLIF with bilateral facetectomy. The major contributors to lordosis recreation were PCO, and PLIF with paired shorter cages rather than TLIF.

Conclusion: This study demonstrates that the surgical approach to posterior interbody surgery influences lordosis gain and PCO optimizes lordosis gain in TLIF. The bilateral cages used in PLIF are shorter and associated with further gain in lordosis. This information has the potential to aid surgical planning when attempting to recreate lordosis to optimize outcomes.

Level of evidence: N/A.

PubMed Disclaimer

References

    1. Kumar MN, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 2001; 10:314–319.
    1. Nakashima H, Kawakami N, Tsuji T, et al. Adjacent segment disease after posterior lumbar interbody fusion: based on cases with a minimum of 10 years of follow-up. Spine (Phila Pa 1976) 2015; 40:E831–E841.
    1. Heo Y, Park JH, Seong HY, et al. Symptomatic adjacent segment degeneration at the L3-4 level after fusion surgery at the L4-5 level: evaluation of the risk factors and 10-year incidence. Eur Spine J 2015; 24:2474–2480.
    1. Smith MW, Annis P, Lawrence BD, et al. Early proximal junctional failure in patients with preoperative sagittal imbalance. Evid Based Spine Care J 2013; 4:163–164.
    1. Terran J, Schwab F, Shaffrey CI, et al. The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery 2013; 73:559–568.

LinkOut - more resources