Morphological changes of contralateral intervertebral foramen induced by cage insertion orientation after unilateral tra
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(2019) 14:79
RESEARCH ARTICLE
Open Access
Morphological changes of contralateral intervertebral foramen induced by cage insertion orientation after unilateral transforaminal lumbar interbody fusion Kai Zhu1, Shuaifeng Yan1, Song Guo1, Jinyu Tong1, Cong Li1, Jun Tan1* and Weiping Wan2*
Abstract Background: This study was performed to investigate the morphological changes of contralateral intervertebral foramen (IVF) based on computed tomography images of patients with lumbar spinal stenosis after unilateral transforaminal lumbar interbody fusion (TLIF) and to compare the influence of different orientation of cage insertion on these changes. Methods: This is a retrospective cohort study. Sixty-nine patients with lumbar spinal stenosis who had undergone single-level unilateral TLIF were retrospectively analyzed. The patients were divided into two groups according to the cage insertion orientation: the oblique group (o-group, 39 cases) and the transverse group (t-group, 30 cases). The morphological parameters of contralateral IVF were measured before and 6 months after the operation. Changes in these parameters were compared and analyzed between the two groups. The 6-month clinical outcomes of the two groups were also collected and analyzed. Results: There was a significant difference in the rate of increase in the segmental angle (p < 0.01) between the two groups, the mean value of segmental angle increased by an average of 29.08% ± 14.93% in the o-group and 48.63% ± 12.01% in the t-group. Overall, the posterior disc height had a significant positive correlation with the foraminal height and area. In the o-group, however, an increase in the segmental angle resulted in a decrease in the foraminal area. No significant difference in clinical outcomes was found between the two groups. Conclusions: Compared with oblique cage insertion, transverse cage insertion could achieve greater restoration of segmental lumbar lordosis without decreasing contralateral foraminal dimensions. Keywords: Transforaminal lumbar interbody fusion, Intervertebral foramen, Cage, Segmental angle, Lumbar spinal stenosis
Background Transforaminal lumbar interbody fusion (TLIF) was introduced by Harms and Rolinger in 1982 [1] and popularized by Harms and Jeszenszky D in 1998 [2]. Since then, its effectiveness and safety have been demonstrated in a large number of literature. The best indications for TLIF procedure include degenerative * Correspondence: [email protected]; [email protected] 1 Department of Orthopaedic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd, Pudong New District, Shanghai 200120, China 2 Department of Radiology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China
spondylolistheses, recurrent disc herniation, spinal stenosis with segmental instability, and discogenic back pain that is unresponsive to conservative treatment [3– 5]. TLIF has many advantages over other infusion techniques, such as less blood loss, less nerve root retraction, an
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