Abstract
Introduction
Preoperative difference in lumbar lordosis (DiLL) was associated with surgical outcomes
after single-level transforaminal lumbar interbody fusion (TLIF). Patients with DiLL>0
(DiLL (+)) tended to show worse clinical outcomes and postoperative greater restoration
of lumbar lordosis (LL). However, some patients with DiLL (+) showed relatively good
outcomes and no postoperative LL restration. This study aimed to elucidate whether
the lumbar intervertebral disc vacuum phenomenon (VP) influences clinical course after
single-level TLIF in patients with DiLL (+) and DiLL (−).
Methods
Patients with lumbar spinal stenosis and degenerative spondylolisthesis treated with
single-level TLIF were included. Pre- and postoperative LL were measured, and postoperative
LL improvement was calculated. Preoperative DiLL was calculated as preoperative supine
LL minus standing LL. Severity of VP at the non-fused discs (SVP (non-FS)) was evaluated
using preoperative reconstructed computed tomography imaging. Clinical outcomes were
assessed using the Oswestry disability index, visual analogue scale (VAS; low back
pain (LBP), lower-extremity pain, numbness, and the Japanese Orthopaedic Association
Back Pain Evaluation Questionnaire. Patients were stratified by the median preoperative
SVP (non-FS) score into severe and mild VP groups in patients with DiLL (+) or DiLL
(−), and their surgical outcomes were compared.
Results
Overall, 89 patients were included. In patients with DiLL (+) (n = 37), patients with
severe VP showed worse clinical outcomes, particulary for LBP and DiLL (+) patients
with mild VP showed greater LL improvement (6.5° ± 10.0°). In patients with DiLL(−)
(n = 52), patients with severe VP showed worse clinical outcomes, particularly for
LBP and no differences in preoperative, postoperative, and improvement of LL were
observed between two groups.
Conclusion
Patients with DiLL (+) and DiLL (−) showed different clinical courses depending on
VP severity at the non-fused discs after single-level TLIF.
Keywords
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Article info
Publication history
Published online: January 24, 2023
Accepted:
January 8,
2023
Received in revised form:
December 17,
2022
Received:
September 9,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.
