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Analyzing the efficacy of transforaminal lumbar interbody fusion (TLIF) surgery for degenerative spondylolisthesis based on clinical outcomes and spinopelvic metrics

Yıl 2024, Cilt: 5 Sayı: 6, 314 - 319, 23.12.2024

Öz

Aims: Transforaminal lumbar interbody fusion (TLIF) is an increasingly used approach for treating degenerative spondylolisthesis, but limited data exist regarding its impact on spinopelvic alignment (SA) and related functional outcomes.
Methods: 150 patients who underwent TLIF were enrolled and evaluated pre-operatively and post-operatively in this study. Radiographic analysis was used to measure spinopelvic parameters, including lumbar lordosis (LL), pelvic tilt (PT) and sacral slope (SS). Oswestry disability index (ODI) and visual analog scale (VAS) functional outcomes were assessed. Methods statistical analyses included paired t-tests, Pearson correlation coefficients, and multivariate regression for differences in parameters before and after surgery, associations between changes in spinopelvic parameters and functional outcomes, and predictors of greater improvement in the ODI, respectively.
Results: Changes in LL, PT and SS from pre- to post-operative day 10, 30-points posterior pelvic plane re-orientation score. Functional output assessments showed improvement in mean ODI (34 to 20) and VAS (6.5 to 3.2) scores (p<0.001). Pre-operative ODI, post-operative change in LL, PT and SS predicted recovery above chance by multivariate regression (p<0.001).
Conclusion: TLIF provides correction to SA and functional outcomes, supporting the importance of pre-operative assessment and targeted surgical planning to optimize quality of life at maximum value for each patient. Longer-term recovery and other pertinent outcome variables should be conducted.

Kaynakça

  • Akkawi I, Zmerly H. Degenerative spondylolisthesis: a narrative review. Acta Bio Medica: Atenei Parmensis. 2022;92(6):e2021313.
  • García-Ramos C, Valenzuela-González J, Baeza-Álvarez V, Rosales-Olivarez L, Alpizar-Aguirre A, Reyes-Sánchez A. Degenerative spondylolisthesis I: general principles. Acta Ortopédica Mexicana. 2021;34(5):324-328.
  • Austevoll IM, Hermansen E, Fagerland MW, et al. Decompression with or without fusion in degenerative lumbar spondylolisthesis. New Engl J Med. 2021;385(6):526-538.
  • Mazurek M, Kulesza B, Gołębiowska N, Tyzo B, Kura K, Szczepanek D. Factors predisposing to the formation of degenerative spondylolisthesis-a narrative review. Medicina. 2023;59(8):1430.
  • Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye AD. Spondylolisthesis. Orthop Rev (Pavia). 2022;14(3):36917.
  • Rivollier M, Marlier B, Kleiber J-C, Eap C, Litre C-F. Surgical treatment of high-grade spondylolisthesis: technique and results. J Orthop. 2020;22(11): 383-389.
  • Suits WH. Clinical measures of pelvic tilt in physical therapy. Int J Sports Phys Ther. 2021;16(5):1366.
  • Lenz M, Oikonomidis S, Hartwig R, et al. Clinical outcome after lumbar spinal fusion surgery in degenerative spondylolisthesis: a 3-year follow-up. Arch Orthop Trauma Surg. 2022;142(5):721-727.
  • Jacob KC, Patel MR, Collins AP, et al. The effect of the severity of preoperative disability on patient-reported outcomes and patient satisfaction following minimally invasive transforaminal lumbar interbody fusion. World Neurosurg. 2022;159:e334-e46.
  • Marques R, Silva AC, Nogueira J, Afonso M, Duarte N. Spinopelvic parameters in the clinical and functional outcomes of patients submitted to lumbar interbody fusion surgery–a prospective study. Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurg. 2023;42(3):e210-e219.
  • Jain M, Sethy SS, Sahoo A, Khan S, Tripathy S, Ramasubbu MK. Effect of approach based lumbar interbody fusion on sagittal spinopelvic parameters and functional outcomes: comparison between oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF). Indian J Orthop. 2024:1-7. doi. 10.1007/s43465-024-01229-w
  • Yang P, Dong Y, Xu Y, Kang H, Li F, Guan H. The research on spinopelvic parameters and clinical outcomes of oblique lumbar interbody fusion and transforaminal lumbar interbody fusion in the treatment of complex degenerative lumbar spondylolisthesis. World Neurosurg. 2024;190: e841-e850.
  • Lee HR, Park J, Ham D-W, Kwon B-T, Go SJ, Kim H-J. Functional mobility tests for evaluation of functionalities in patients with adult spinal deformity. BMC Musculoskelet Disord. 2022;23(1):391.
  • Kothari PH, Palekar TJ, Shah MR, Mujawar S. Effects of conventional physiotherapy treatment on kinesiophobia, pain, and disability in patients with mechanical low back pain. J Dental Res Rev. 2020;7(Suppl 1):S76-S78.
  • Liow MHL, Goh GS-H, Chua JL, et al. Sagittally balanced degenerative spondylolisthesis patients with increased sacral slope and greater lumbar lordosis experience less back pain after short-segment lumbar fusion surgery. Clin Spine Surg. 2020;33(5):E231-E235.
  • Jacob KC, Patel MR, Parsons AW, et al. The effect of the severity of preoperative back pain on patient-reported outcomes, recovery ratios, and patient satisfaction following minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). World Neurosurg. 2021;156:e254-e65.
  • Massel DH, Mayo BC, Narain AS, et al. Improvements in back and leg pain following a minimally invasive transforaminal lumbar interbody fusion. Int J Spine Surg. 2020;14(5):745-55.
  • Kwon J-W, Park Y, Lee BH, et al. Ten-year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion in patients with single-level lumbar spondylolisthesis. Spine. 2022;47(11):773-780.
  • Friedman BW, Mahony SO, Mulvey L, et al. One-week and 3-month outcomes after an emergency department visit for undifferentiated musculoskeletal low back pain. Ann Emerg Med. 2012;59(2):128-33.e3.
  • Poppenborg P, Liljenqvist U, Gosheger G, et al. Complications in TLIF spondylodesis–do they influence the outcome for patients? A prospective two-center study. Eur Spine J. 2021;30(5):1320-1328.
  • Pan C, Wang G, Wang X, et al. Predictive formulae of ideal lumbar lordosis determined by individual pelvic incidence and thoracic kyphosis in asymptomatic adults. J Orthop Sci. 2022;27(1):101-107.
  • Rieger F, Rothenfluh DA, Ferguson SJ, Ignasiak D. Comprehensive assessment of global spinal sagittal alignment and related normal spinal loads in a healthy population. J Biomech. 2024;170:112127.

Dejeneratif spondilolistezis için transforaminal lomber interbody füzyon (TLIF) cerrahisinin etkinliğinin klinik sonuçlar ve spinopelvik ölçümlere göre incelenmesi

Yıl 2024, Cilt: 5 Sayı: 6, 314 - 319, 23.12.2024

Öz

Giriş: Transforaminal lomber interbody füzyon (TLIF) dejeneratif spondilolistezis tedavisinde giderek daha fazla kullanılan bir yaklaşımdır, ancak spinopelvik dizilim ve ilgili fonksiyonel sonuçlar üzerindeki etkisine ilişkin sınırlı veri mevcuttur.
Yöntem: Bu çalışmaya TLIF uygulanan 150 hasta dahil edildi ve ameliyat öncesi ve sonrası değerlendirildi. Lomber lordoz (LL), pelvik tilt (PT) ve sakral eğim (SS) dahil olmak üzere spinopelvik parametreleri ölçmek için radyografik analiz kullanıldı. Oswestry Engellilik İndeksi (ODI) ve Görsel Analog Skala (VAS) fonksiyonel sonuçları değerlendirilmiştir. Yöntemler İstatistiksel analizler sırasıyla eşleştirilmiş t-testleri, Pearson korelasyon katsayıları ve ameliyat öncesi ve sonrası parametrelerdeki farklılıklar, spinopelvik parametrelerdeki değişiklikler ile fonksiyonel sonuçlar arasındaki ilişkiler ve ODI'de daha fazla iyileşmenin belirleyicileri için çok değişkenli regresyonu içeriyordu.
Bulgular: Ameliyat öncesinden ameliyat sonrası 10. güne kadar LL, PT ve SS'deki değişiklikler, 30 puanlık posterior pelvik düzlem yeniden oryantasyon skoru. Fonksiyonel çıktı değerlendirmeleri ortalama ODI (34'ten 20'ye) ve VAS (6.5'ten 3.2'ye) skorlarında iyileşme gösterdi (p <0.001). Ameliyat öncesi ODI, ameliyat sonrası LL, PT ve SS'deki değişim çok değişkenli regresyon ile şansın üzerinde iyileşmeyi öngörmüştür (p < 0.001).
Sonuç: TLIF, spinopelvik dizilimde ve fonksiyonel sonuçlarda düzeltme sağlayarak, her hasta için yaşam kalitesini maksimum değerde optimize etmek için ameliyat öncesi değerlendirmenin ve hedefe yönelik cerrahi planlamanın önemini desteklemektedir. Daha uzun dönem iyileşme ve diğer ilgili sonuç değişkenleri araştırılmalıdır.

Kaynakça

  • Akkawi I, Zmerly H. Degenerative spondylolisthesis: a narrative review. Acta Bio Medica: Atenei Parmensis. 2022;92(6):e2021313.
  • García-Ramos C, Valenzuela-González J, Baeza-Álvarez V, Rosales-Olivarez L, Alpizar-Aguirre A, Reyes-Sánchez A. Degenerative spondylolisthesis I: general principles. Acta Ortopédica Mexicana. 2021;34(5):324-328.
  • Austevoll IM, Hermansen E, Fagerland MW, et al. Decompression with or without fusion in degenerative lumbar spondylolisthesis. New Engl J Med. 2021;385(6):526-538.
  • Mazurek M, Kulesza B, Gołębiowska N, Tyzo B, Kura K, Szczepanek D. Factors predisposing to the formation of degenerative spondylolisthesis-a narrative review. Medicina. 2023;59(8):1430.
  • Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye AD. Spondylolisthesis. Orthop Rev (Pavia). 2022;14(3):36917.
  • Rivollier M, Marlier B, Kleiber J-C, Eap C, Litre C-F. Surgical treatment of high-grade spondylolisthesis: technique and results. J Orthop. 2020;22(11): 383-389.
  • Suits WH. Clinical measures of pelvic tilt in physical therapy. Int J Sports Phys Ther. 2021;16(5):1366.
  • Lenz M, Oikonomidis S, Hartwig R, et al. Clinical outcome after lumbar spinal fusion surgery in degenerative spondylolisthesis: a 3-year follow-up. Arch Orthop Trauma Surg. 2022;142(5):721-727.
  • Jacob KC, Patel MR, Collins AP, et al. The effect of the severity of preoperative disability on patient-reported outcomes and patient satisfaction following minimally invasive transforaminal lumbar interbody fusion. World Neurosurg. 2022;159:e334-e46.
  • Marques R, Silva AC, Nogueira J, Afonso M, Duarte N. Spinopelvic parameters in the clinical and functional outcomes of patients submitted to lumbar interbody fusion surgery–a prospective study. Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurg. 2023;42(3):e210-e219.
  • Jain M, Sethy SS, Sahoo A, Khan S, Tripathy S, Ramasubbu MK. Effect of approach based lumbar interbody fusion on sagittal spinopelvic parameters and functional outcomes: comparison between oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF). Indian J Orthop. 2024:1-7. doi. 10.1007/s43465-024-01229-w
  • Yang P, Dong Y, Xu Y, Kang H, Li F, Guan H. The research on spinopelvic parameters and clinical outcomes of oblique lumbar interbody fusion and transforaminal lumbar interbody fusion in the treatment of complex degenerative lumbar spondylolisthesis. World Neurosurg. 2024;190: e841-e850.
  • Lee HR, Park J, Ham D-W, Kwon B-T, Go SJ, Kim H-J. Functional mobility tests for evaluation of functionalities in patients with adult spinal deformity. BMC Musculoskelet Disord. 2022;23(1):391.
  • Kothari PH, Palekar TJ, Shah MR, Mujawar S. Effects of conventional physiotherapy treatment on kinesiophobia, pain, and disability in patients with mechanical low back pain. J Dental Res Rev. 2020;7(Suppl 1):S76-S78.
  • Liow MHL, Goh GS-H, Chua JL, et al. Sagittally balanced degenerative spondylolisthesis patients with increased sacral slope and greater lumbar lordosis experience less back pain after short-segment lumbar fusion surgery. Clin Spine Surg. 2020;33(5):E231-E235.
  • Jacob KC, Patel MR, Parsons AW, et al. The effect of the severity of preoperative back pain on patient-reported outcomes, recovery ratios, and patient satisfaction following minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). World Neurosurg. 2021;156:e254-e65.
  • Massel DH, Mayo BC, Narain AS, et al. Improvements in back and leg pain following a minimally invasive transforaminal lumbar interbody fusion. Int J Spine Surg. 2020;14(5):745-55.
  • Kwon J-W, Park Y, Lee BH, et al. Ten-year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion in patients with single-level lumbar spondylolisthesis. Spine. 2022;47(11):773-780.
  • Friedman BW, Mahony SO, Mulvey L, et al. One-week and 3-month outcomes after an emergency department visit for undifferentiated musculoskeletal low back pain. Ann Emerg Med. 2012;59(2):128-33.e3.
  • Poppenborg P, Liljenqvist U, Gosheger G, et al. Complications in TLIF spondylodesis–do they influence the outcome for patients? A prospective two-center study. Eur Spine J. 2021;30(5):1320-1328.
  • Pan C, Wang G, Wang X, et al. Predictive formulae of ideal lumbar lordosis determined by individual pelvic incidence and thoracic kyphosis in asymptomatic adults. J Orthop Sci. 2022;27(1):101-107.
  • Rieger F, Rothenfluh DA, Ferguson SJ, Ignasiak D. Comprehensive assessment of global spinal sagittal alignment and related normal spinal loads in a healthy population. J Biomech. 2024;170:112127.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Beyin ve Sinir Cerrahisi (Nöroşirurji)
Bölüm Research Articles [en] Araştırma Makaleleri [tr]
Yazarlar

Fahri Eryılmaz 0000-0002-7030-9279

Yayımlanma Tarihi 23 Aralık 2024
Gönderilme Tarihi 3 Kasım 2024
Kabul Tarihi 11 Aralık 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 5 Sayı: 6

Kaynak Göster

AMA Eryılmaz F. Analyzing the efficacy of transforaminal lumbar interbody fusion (TLIF) surgery for degenerative spondylolisthesis based on clinical outcomes and spinopelvic metrics. J Med Palliat Care / JOMPAC / Jompac. Aralık 2024;5(6):314-319.

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