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

Abstract

Study Design Retrospective cohort study. Purpose The objective of this study was to compare three widely used interbody fusion approaches in regard to their ability to correct sagittal balance, including pelvic parameters. Overview of Literature Restoration of sagittal balance in lumbar spine surgery is associated with better postoperative outcomes. Various interbody fusion techniques can help to correct sagittal balance, with no clear consensus on which technique offers the best correction. Methods The charts and imaging of patients who have undergone surgery through either open transforaminal lumbar interbody fusion (TLIF), minimally invasive TLIF (MIS TLIF), or oblique lumbar interbody fusion (OLIF) were retrospectively reviewed. The following sagittal balance parameters were measured pre- and postoperatively: segmental lordosis, lumbar lordosis, disk height, pelvic tilt, and pelvic incidence. Data on postoperative complications were gathered. Results Only OLIF managed to significantly improve segmental lordosis (4.4°, p <0.001) and lumbar lordosis (4.8°, p =0.049). All approaches significantly augmented disk height, with OLIF having the greatest effect (3.7°, p <0.001). No approaches were shown to significantly correct pelvic tilt. Pelvic incidence remained unchanged in all approaches. Open TLIF was the only approach with a higher rate of postoperative complications (33%, p =0.009). Conclusions The OLIF approach might offer greater correction of sagittal balance over open and MIS TLIF, mainly in regard to segmental lordosis, lumbar lordosis, and disk height. MIS TLIF, although offering more limited access than open TLIF, was not inferior to open TLIF in regard to sagittal balance correction. A higher rate of complications was shown for open TLIF than the other approaches, possibly due to its more invasive nature.

Usefulness of Oblique Lateral Interbody Fusion at L5–S1 Level Compared to Transforaminal Lumbar Interbody Fusion

“…Each surgeon performed only TLIF or OLIF51 exclusively, which may result in bias. According to previous studies, percutaneous screw system and open pedicle screw system have not been reported to cause any significant difference to lumbosacral sagittal angle 15) . We preserved the contralateral half of the ALL.…”

The clinical and radiographic outcomes of stand-alone Oblique Lateral Interbody Fusion in Treatment of Adult Degenerative Scoliosis

“…Biomechanical studies have shown that the recovery of LL was beneficial to increase the tension of the anterior longitudinal ligament, which could improve the intervertebral fusion rate and reduce the rate of degeneration of adjacent segments [22]. Another study [23] also found that the key to the recovery of the sagittal balance of the lumbar spine was to restore LL. The recovery of the sagittal balance can reduce the adjacent segmental degeneration caused by the compensated sagittal imbalance and improve the patient's symptoms.…”

Lumbar Interbody Fusion: Techniques, Pearls and Pitfalls

“…Additionally, TLIF may be preferable in the revision cases, because the lateral access may avoid the postoperative scar tissue on the posterior approach [ 26 - 28 ]. Recently, MIS techniques have gained popularity because these techniques may show favorable results such as reduced blood loss and muscle injury, operative time, and an early postoperative recovery than the traditional open techniques [ 23 , 29 - 34 ].…”

“…The surgical oblique view during OLIF is much favorable for the surgeons as compared to LLIF, which only allows a vertical view. Similar to LLIF, OLIF can provide indirect neural decompression and deformity correction [ 29 , 56 , 83 , 84 ]. Meta-analyses have showed that the risks of ipsilateral hip flexor weakness, transient thigh pain, and lumbar plexus injury are lower in OLIF than in LLIF [ 77 , 85 , 86 ].…”