Lumbar Lordosis Correction With Transforaminal Lumbar Interbody Fusion in Adult Spinal Deformity Patients with Minimum 2-Year Follow-up

Objective: To determine the degree of lumbar lordosis (LL) correction possible via transforaminal lumbar interbody fusion (TLIF) in adult spinal deformity patients. Methods: A retrospective chart review identified patients ≥18 years of age with severe positive sagittal balance defined by the SRS-Schwab classification: pelvic incidence to LL mismatch >20°, sagittal vertical axis >9.5cm, and/or pelvic tilt >30°. All patients had surgery between 2013 to 2018 with a TLIF at L4-L5 and/or L5-S1 by the senior author (J.L.F.) with ≥2-years follow-up. Results: Sixty-one patients (18 men, 43 women) with 85 TLIFs were included with an average age of 66 years and average follow-up of 50 months. Average lumbar lordosis (L1-S1) improved from 27° preoperative to 48° postoperative and 45° at 2-year follow-up (P < 0.001). Average segmental lordosis at L4-L5 TLIF sites improved from 3° preoperative to 13° postoperative and persisted at 2-year follow-up (P < 0.001). Segmental lordosis at L5-S1 TLIF sites improved from 7° preoperative to 21° postoperative and 20° at 2-year follow-up (P < 0.001). Seventeen of the TLIFs (20%) had >20° of segmental lordosis improvement at long-term follow-up. The rate of revision surgery for pseudoarthrosis at the TLIF level was 5%. Conclusions: Significant lordosis correction can be achieved through an open TLIF in patients with severe positive sagittal balance when utilizing meticulous deformity correction techniques, avoiding the added morbidity of an anterior approach or a 3-column osteotomy.