Bilateral decompression during unilateral transforaminal lumbar interbody fusion significantly reduces contralateral radiculopathy: A retrospective analysis

Abstract

ObjectiveTo determine the effectiveness of bilateral decompression combined with a unilateral transforaminal lumbar interbody fusion approach in centralizing a lordotic cage and preventing contralateral radiculopathy by ensuring equal foraminal elevation.MethodsThis is a retrospective cohort study based on clinical records and radiological data. Eighty-seven patients diagnosed with lumbar spinal stenosis at L3-S1 levels underwent bilateral decompression and transforaminal lumbar interbody fusion between 2017 and 2022. The procedures were performed through a posterior midline incision, followed by insertion of a lordotic cage to restore spinal alignment. Fluoroscopy and microscopy confirmed the precise placement of the cage. Clinical outcomes were assessed using visual analog scale and Oswestry disability index scores, with radiological evaluations through computed tomography and magnetic resonance imaging.ResultsPostoperative imaging demonstrated the centralization of the lordotic cage in both anteroposterior and lateral planes, ensuring equal foraminal elevation bilaterally. The visual analog scale and Oswestry disability index scores significantly improved at all follow-up intervals. The incidence of contralateral radiculopathy was minimized (1%) due to prophylactic decompression, and the foraminal area increased by more than 20%.ConclusionsBilateral decompression combined with a unilateral transforaminal lumbar interbody fusion approach enables effective stabilization and alignment of spinal segments. The central placement of the lordotic cage contributes to symmetrical foraminal elevation, reducing the risk of contralateral radiculopathy.

Keywords: Transforaminal lumbar interbody fusion; bilateral decompression; contralateral radiculopathy; foraminal elevation; lordotic cage; spinal stenosis.

Figure 1.

(a) Change in VAS scores over time: low back pain and leg pain VAS scores decreased over four time points, indicating pain reduction. (b) Change in ODI scores over time: ODI scores declined over time, reflecting improved patient function and (c) preoperative vs. postoperative measurements: disc height and foraminal area improved post-surgery, demonstrating treatment effectiveness. VAS: visual analog scale; ODI: Oswestry disability index.

Figure 2.

Pre- and postoperative intervertebral disc space. The postoperative image shows an increase in disc angle and distance, indicating successful decompression and stabilization of the spinal segment.

Figure 3.

Centralization of the lordotic cage in both anteroposterior and lateral planes, ensuring equal elevation of both foramina. This positioning achieves optimal alignment and stabilization of the spinal segment.