Abstract
Background
Postoperative changes in lumbar lordosis (LL) after transforaminal lumbar interbody
fusion (TLIF) and the related factors are not well-understood. Recently, the preoperative
difference in LL between standing and supine positions (DiLL) was proposed as a factor
for predicting postoperative radiologic outcomes after short-segment TLIF. This study
investigated the influence of DiLL on mid-term radiological outcomes after short-segment
TLIF.
Methods
Sixty-six patients with lumbar degenerative disease treated with short-segment TLIF
(1–2 levels) who underwent lumbar spine standing radiographs at 3 months, 6 months,
1 year, 2 years, 3 years, 4 years, and 5 years postoperatively were divided into DiLL
(+) and DiLL (−) groups (preoperative DiLL ≥0° and <0°, respectively). Associations
between the postoperative change in LL and DiLL and clinical outcomes (Oswestry disability
index (ODI) and Nakai score) were evaluated.
Results
Temporary restoration of LL (+4.5°) until 1 year postoperatively and a subsequent
decrease in LL from 1 to 5 years postoperatively (−5.3°) was observed in the DiLL
(+) group. No postoperative change in LL was observed in the DiLL (−) group. Postoperative
changes in LL were mainly observed in non-fused segments. The postoperative change
in LL (ΔLL) until 1 year postoperatively had a significant positive association with
DiLL (p = 0.00028), whereas ΔLL from 1 to 5 years postoperatively showed a significant
negative association with DiLL (p = 0.010) and a positive association with Nakai score
(p = 0.028). ΔLL until 5 years postoperatively showed a significant positive association
with postoperative ODI improvement (p = 0.011).
Conclusions
DiLL (+) patients showed a specific time course with temporary LL restoration until
1 year postoperatively and a subsequent decrease in LL from 1 to 5 years postoperatively.
Patients with larger postoperative increase in LL until 5 years postoperatively and
lesser decrease in LL from 1 to 5 years postoperatively tended to show better mid-term
clinical outcomes.
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Article info
Publication history
Published online: December 24, 2021
Accepted:
November 29,
2021
Received in revised form:
October 29,
2021
Received:
August 11,
2021
Identification
Copyright
© 2021 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.
