MEASUREMENT OF LUMBAR LORDOSIS: COMPARATIVE RADIOLOGICAL STUDY OF ANTERIOR/POSTERIOR LUMBAR FUSION VERSUS TRANSFORAMINAL LUMBAR INTERBODY FUSION

Abstract

Purpose: To review the sagittal lumbar and clinical profile of the two surgical procedures: TLIF (transforaminal lumbar interbody fusion and ALIF (anterior lumbar interbody fusion).

Materials and methods: We carried out a retrospective study of 46 patients who underwent circumferential fusion in 2000–2001. TLIF was used in the first group (21) and ALIF in the second (25). The posterior approach with pedicle instrumentation was used in all patients. Lateral radiographs of the lumbar spine in neutral position and bipedestation were used for evaluation before and after surgery and during follow-up. The results were compared statistically using the Wilcoxon matched pairs test.

Results: Lumbar lordosis was achieved with both techniques: TLIF+PF(posterior fusion) −33° (preoperative), −46° (postoperative) and ALIF+ PF −49° (preoperative), −54° (postoperative). However the height of the disc improved significantly with the anterior approach: TLIF+ PF 0.62 (preoperative), 1.35 (postoperative) and ALIF+PF 1 (preoperative), 4.65 (postoperative).

The duration of surgery, blood loss and hospital stay were greater with ALIF+PF than with TLIF+PF.

Conclusions: TLIF+PF has clinical and economic advantages over ALIF+PF. Lumbar lordosis and the area of instrumented lordosis was achieved with both circumferential fusion procedures and the only radiographic difference was the restoration of the disc height with ALIF.