A Comparison of Radiographic Alignment between Bilateral and Unilateral Interbody Cages in Patients Undergoing Transforaminal Lumbar Interbody Fusion.

Authors

• Mark James Lambrechts
• Jeremy Heard
• Nicholas D'Antonio
• John Bodnar
• Gregory Schneider
• Evan Bloom
• Jose Canseco
• Barrett Woods
• Ian David Kaye
• Mark Kurd
• Jeffrey Rihn
• Alan Hilibrand
• Gregory Schroeder
• Alexander Vaccaro
• Christopher Kepler

Publication/Presentation Date

8-1-2023

Abstract

STUDY DESIGN: Retrospective cohort study.

PURPOSE: To compare radiographic outcomes between unilateral and bilateral cage placement in transforaminal lumbar interbody fusions (TLIF) and to determine if the rate of fusion at the 1-year postoperative point was different in patients who received bilateral versus unilateral cages.

OVERVIEW OF LITERATURE: There is no clear evidence to dictate whether bilateral or unilateral cages promote superior radiographic or surgical outcomes in TLIF.

METHODS: Patients >18 years old who underwent primary one- or two-level TLIFs at our institution were identified and propensitymatched in a 3:1 fashion (unilateral:bilateral). Patient demographics, surgical characteristics, and radiographic outcomes, including vertebral endplate obliquity, segmental lordosis, subsidence, and fusion status, were compared between groups.

RESULTS: Of the 184 patients included, 46 received bilateral cages. Bilateral cage placement was associated with greater subsidence (1.06±1.25 mm vs. 0.59±1.16 mm, p=0.028) and enhanced restoration of segmental lordosis (5.74°±14.1° vs. -1.57°±10.9°, p=0.002) at the 1-year postoperative point, while unilateral cage placement was associated with an increased correction of endplate obliquity (-2.02°±4.42° vs. 0.24°±2.81°, p< 0.001). Bilateral cage placement was significantly associated with radiographic fusion on bivariate analysis (89.1% vs. 70.3%, p=0.018) and significantly predicted radiographic fusion on multivariable regression analysis (estimate, 1.35; odds ratio, 3.87; 95% confidence interval, 1.51-12.05; p=0.010).

CONCLUSIONS: Bilateral interbody cage placement in TLIF procedures was associated with restoration of lumbar lordosis and increased fusion rates. However, endplate obliquity correction was significantly greater for patients who received a unilateral cage.

Volume

17

Issue

4

First Page

666

Last Page

675

ISSN

1976-1902

Published In/Presented At

Lambrechts, M. J., Heard, J., D'Antonio, N., Bodnar, J., Schneider, G., Bloom, E., Canseco, J., Woods, B., Kaye, I. D., Kurd, M., Rihn, J., Hilibrand, A., Schroeder, G., Vaccaro, A., & Kepler, C. (2023). A Comparison of Radiographic Alignment between Bilateral and Unilateral Interbody Cages in Patients Undergoing Transforaminal Lumbar Interbody Fusion. Asian spine journal, 17(4), 666–675. https://doi.org/10.31616/asj.2022.0316

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

37226381

Department(s)

Administration and Leadership

Document Type

Article