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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(05): 821-827
DOI: 10.1055/s-0042-1756215
Artigo Original
Coluna

Correlation Between Cage Positioning and Lumbar Lordosis in Transforaminal Lumbar Interbody Fusion (TLIF)

Article in several languages: português | English
Emiliano Neves Vialle 
1   Grupo de Cirurgia da Coluna, Departamento de Ortopedia e Traumatologia, Hospital Universitário Cajuru, Curitiba, PR, Brasil
,
Guilherme Zandavalli Ramos 
1   Grupo de Cirurgia da Coluna, Departamento de Ortopedia e Traumatologia, Hospital Universitário Cajuru, Curitiba, PR, Brasil
,
Fabian Lopez Hinojosa 
2   Grupo de Cirurgia da Coluna, Departamento de Ortopedia e Traumatologia, Hospital Angeles Valle Oriente, Monterrey, Nuevo León, México
,
Alfredo Guiroy 
3   Unidad de Patología Espinal, Hospital Español de Mendoza, Mendoza, Argentina
,
Luiz Gustavo Dal'Oglio da Rocha 
1   Grupo de Cirurgia da Coluna, Departamento de Ortopedia e Traumatologia, Hospital Universitário Cajuru, Curitiba, PR, Brasil
,
André de Oliveira Arruda 
1   Grupo de Cirurgia da Coluna, Departamento de Ortopedia e Traumatologia, Hospital Universitário Cajuru, Curitiba, PR, Brasil
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Abstract

Objective The present study evaluates radiographic outcomes and the lumbar lordosis achieved with a transforaminal lumbar interbody fusion (TLIF) arthrodesis technique according to the positioning of an interbody device (cage) in the disc space.

Methods This is a retrospective radiographic analysis of single-level surgical patients with degenerative lumbar disease submitted to a TLIF procedure and posterior pedicle instrumentation. We divided patients into two groups according to cage positioning. For the TLIF-A group, the cages were anterior to the disc space; for the TLIF-P group, cages were posterior to the disc space. Considering the superior vertebral plateau of the lower vertebra included in the instrumentation, cages occupying a surface equal to the anterior 50% of the midline were placed in the TLIF-A group, and those in a posterior position were placed in the TLIF-P group. We assessed pre- and postoperative orthostatic lateral radiographs to obtain the following measures: lumbar lordosis (LL) (angle L1–S1), segmental lordosis (LS) (L4–S1), and segmental lordosis of the cage (SLC).

Results The present study included 100 patients from 2011 to 2018; 44 were males, and 46 were females. Their mean age was 50.5 years old (range, 27 to 76 years old). In total, 43 cages were “anterior” (TLIF-A) and 57 were “posterior” (TLIF-P). After surgery, the mean findings for the TLIF-A group were the following: LL, 50.7°, SL 34.9°, and SLC 21.6°; in comparison, the findings for the TLIF-P group were the following: LL, 42.3° (p < 0.01), SL 30.7° (p < 0.05), and SLC 18.8° (p > 0.05).

Conclusion Cage positioning anterior to the disc space improved lumbar and segmental lordosis on radiographs compared with a posterior placement.

Keywords

spondylolisthesis - lordosis - spinal fusion - lumbosacral region

Financial Support

The present study received no financial support from either public, commercial, or not-for-profit sources.


* Work developed in the Spine Surgery Group of the Department of Orthopedics and Traumatology, Hospital Universitário Cajuru, Curitiba, Brazil.




Publication History

Received: 07 November 2021

Accepted: 27 June 2022

Article published online:
10 October 2022

© 2022. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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