Minimally invasive transforaminal lumbar interbody fusion with expandable versus static interbody devices: radiographic assessment of sagittal segmental and pelvic parameters

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has been adopted as an alternative technique to hasten recovery and minimize postoperative morbidity. Advances in instrumentation technologies and operative techniques have evolved to maximize patient outcomes as well as radiographic results. The development of expandable interbody devices allows a surgeon to perform MIS-TLIF with minimal tissue disruption. However, sagittal segmental and pelvic radiographic outcomes after MIS-TLIF with expandable interbody devices are not well characterized. The object of this study is to evaluate the radiographic sagittal lumbar segmental and pelvic parameter outcomes of MIS-TLIF performed using an expandable interbody device.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A retrospective review of MIS-TLIFs performed between 2014 and 2016 at a high-volume center was performed. Radiographic measurements were performed on lateral radiographs before and after MIS-TLIF with static or expandable interbody devices. Radiographic measurements included disc height, foraminal height, fused disc angle, lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt. Mismatch between pelvic incidence and lumbar lordosis were calculated for each radiograph.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 48 MIS-TLIFs were performed, predominantly at the L4–5 level, in 44 patients. MIS-TLIF with an expandable interbody device led to a greater and more sustained increase in disc height when compared with static interbody devices. Foraminal height increased after MIS-TLIF with expandable but not with static interbody devices. MIS-TLIF with expandable interbody devices increased index-level segmental lordosis more than with static interbody devices. The increase in segmental lordosis was sustained in the patients with expandable interbody devices but not in patients with static interbody devices. For patients with a collapsed disc space, MIS-TLIF with an expandable interbody device provided superior and longer-lasting increases in disc height, foraminal height, and index-level segmental lordosis than in comparison with patients with static interbody devices. Using an expandable interbody device improved the Oswestry Disability Index scores more than using a static interbody device, and both disc height and segmental lordosis were correlated with improved clinical outcome. Lumbar MIS-TLIF with expandable or static interbody devices had no effect on overall lumbar lordosis, pelvic parameters, or pelvic incidence–lumbar lordosis mismatch.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Performing MIS-TLIF with an expandable interbody device led to a greater and longer-lasting restoration of disc height, foraminal height, and index-level segmental lordosis than MIS-TLIF with a static interbody device, especially for patients with a collapsed disc space. However, neither technique had any effect on radiographic pelvic parameters.</jats:p></jats:sec>

Sagittal Balance Correction Following Lumbar Interbody Fusion: A Comparison of the Three Approaches

“…Given that these parameters encompass the whole lumbar spine, patients surgically treated on levels other than L5–S1 were excluded from the analysis, leaving very few patients in some groups (e.g., two patients in the OLIF group). Also, the impact on spinal alignment was minimized because only one level was surgically treateGiven the more restricted access, concerns have been raised about the capacity of MIS TLIF to offer adequate correction of sagittal balance [22,27,28] ; and, to date, it has not been directly compared with open TLIF in that regard. In the current study, MIS TLIF is not inferior to open TLIF in regard to sagittal balance correction, and it has fewer complications.…”

Assessment of radiographic and clinical outcomes of an articulating expandable interbody cage in minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis

“…20,24,29,32,[37][38][39]42 One controversy with MIS TLIF is the ability to provide adequate reduction of spondylolisthesis and correction of radiographic parameters, or even whether such changes are necessary. 7,8,14,30,33,40 With a growing body of evidence emphasizing the finding that the restoration and maintenance of spinopelvic parameters after spine surgery is associated with improved outcomes, 5,12,17,18,25,34,36,41 there has been interest in applying these principles to MIS TLIF as well. Current product limitations, which include cage footprint size, fixed height of interbody cage, and nonlordotic shape of the implant, have limited the surgeon's armamentarium to achieve these goals by providing inadequate anterior column height restoration through the access corridors of both open and MIS TLIF.…”

Transforaminal lumbar interbody fusion with expandable cages: Radiological and clinical results of banana-shaped and straight implants

“…found better restoration of DH with expandable MIS TLIF devices in comparison to static TLIF implants especially in patients with a collapsed disc. [ 16 ]…”