Newswise — Winner of the Stewart B. Dunsker, MD, Award, Karthik Madhavan, MD, presented his research, Assessment of Sagittal Balance Following TLIF - Are We Kyphosing the Lumbar Spine?, during the 2017 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting.


Transforaminal lumbar interbody fusion (TLIF) has been the "workhorse" spinal procedure for the past decade. However, there remains the challenge of suboptimal lordotic interbody cage placement. The authors proposed that adjustment of spinopelvic parameters play an important role in outcome following TLIF.


The team retrospectively reviewed 730 patients who underwent TLIF surgery. Standing X rays were assessed for changes in disc height, lumbar lordosis, pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). The reoperation rate was assessed as well.


These 730 operations were performed at more than 1,000 levels. Among the 90 patients with kyphosis (12.3 percent), 45 percent had restoration of lordosis. Interestingly, among those with normal lordosis, 57 percent developed kyphosis postoperatively. High PT, SS and PI)were observed in 57 percent, 8.5 percent and 24 percent respectively. However, only 32.1 percent and 60 percent of these patients with high PT and SS were successfully corrected with TLIFs while the high PI was remained unchanged, as expected. The reoperation rate was 4.1 percent and reasons included adjacent segment disease and pseudoarthrosis.


Several factors influence sagittal balance post TLIF including inherent lordosis of the cage, the expandable nature, anterior position of cage and compression of posterior screws. Spino-pelvic parameters are the foundation of spinal correction and any insufficient correction could lead to a situation where the upper body gradually kyphoses forward.


Author Block: Karthik Madhavan, MD; Lee Onn Chieng, BS; Alan Shamrock; Michael Wang; and Steven Vanni


Disclosure: The author reported no conflicts of interest.


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Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 10,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. Fellows of the AANS are board-certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons of Canada or the Mexican Council of Neurological Surgery, A.C. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal cord, brain, nervous system and peripheral nerves.


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