Transforaminal lumbar interbody fusion with or without release of the anterior longitudinal ligament: A single-center, retrospective observational cohort study

Samantha Högl-Roy, BSc; Nader Hejrati, MD; Felix C. Stengel, MD; Stefan Motov, MD; Anand Veeravagu, MD; Benjamin Martens, MD; Martin N. Stienen, MD/FEBNS

North American Spine Society Journal (Sep 2024)

Transforaminal lumbar interbody fusion with or without release of the anterior longitudinal ligament: A single-center, retrospective observational cohort study

Samantha Högl-Roy, BSc,
Nader Hejrati, MD,
Felix C. Stengel, MD,
Stefan Motov, MD,
Anand Veeravagu, MD,
Benjamin Martens, MD,
Martin N. Stienen, MD/FEBNS

Affiliations

Samantha Högl-Roy, BSc: Spine Center of Eastern Switzerland, Kantonsspital St. Gallen & St. Gallen Medical School, Rorschacher Str. 95, St. Gallen 9000, Switzerland; Department of Neurosurgery, Kantonsspital St. Gallen & St. Gallen Medical School, Rorschacher Str. 95, St. Gallen 9000, Switzerland
Nader Hejrati, MD: Spine Center of Eastern Switzerland, Kantonsspital St. Gallen & St. Gallen Medical School, Rorschacher Str. 95, St. Gallen 9000, Switzerland; Department of Neurosurgery, Kantonsspital St. Gallen & St. Gallen Medical School, Rorschacher Str. 95, St. Gallen 9000, Switzerland
Felix C. Stengel, MD: Spine Center of Eastern Switzerland, Kantonsspital St. Gallen & St. Gallen Medical School, Rorschacher Str. 95, St. Gallen 9000, Switzerland; Department of Neurosurgery, Kantonsspital St. Gallen & St. Gallen Medical School, Rorschacher Str. 95, St. Gallen 9000, Switzerland
Stefan Motov, MD: Spine Center of Eastern Switzerland, Kantonsspital St. Gallen & St. Gallen Medical School, Rorschacher Str. 95, St. Gallen 9000, Switzerland; Department of Neurosurgery, Kantonsspital St. Gallen & St. Gallen Medical School, Rorschacher Str. 95, St. Gallen 9000, Switzerland
Anand Veeravagu, MD: Department of Neurosurgery, School of Medicine, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
Benjamin Martens, MD: Spine Center of Eastern Switzerland, Kantonsspital St. Gallen & St. Gallen Medical School, Rorschacher Str. 95, St. Gallen 9000, Switzerland; Department of Orthopedic Surgery, Kantonsspital St. Gallen & St. Gallen Medical School, Rorschacher Str. 95, St. Gallen 9000, Switzerland
Martin N. Stienen, MD/FEBNS: Spine Center of Eastern Switzerland, Kantonsspital St. Gallen & St. Gallen Medical School, Rorschacher Str. 95, St. Gallen 9000, Switzerland; Department of Neurosurgery, Kantonsspital St. Gallen & St. Gallen Medical School, Rorschacher Str. 95, St. Gallen 9000, Switzerland; Corresponding author. Department of Neurosurgery, Co-chair, Spine Center of Eastern Switzerland, Cantonal Hospital of St. Gallen & Medical School of St. Gallen, Rorschacher Str. 95, St. Gallen CH-9007, Switzerland.

Journal volume & issue: Vol. 19
p. 100533

Abstract

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ABSTRACT: Background: Transforaminal anterior release (TFAR) is a technical extension of the transforaminal lumbar interbody fusion (TLIF) procedure with deliberate release of the anterior longitudinal ligament (ALL). Methods: In a retrospective, single-center observational cohort study, consecutive adult patients undergoing TLIF surgery at L4/L5 and/or L5/S1 between 01/2018 and 12/2022 for degenerative disc disease or deformity were considered. The TFAR group (with ALL release) was compared to a standard TLIF group (without ALL release), matched in a 1:3 ratio. Uni- and multivariable logistic regression models were built to estimate the likelihood of any adverse event (AE), reoperation, and excellent/good clinical outcome at 12 months. Results: Of 438 patients, 18 undergoing TFAR were matched to 53 undergoing standard TLIF. TFAR procedures were frequently part of extensive, anterior-posterior or multilevel fusion procedures with longer surgery time and higher blood loss. The rates of intraoperative surgical AEs were similar (16.7 vs. 11.3%, p=.789). The rates and severities of surgical AEs, as well as reoperation rates and clinical outcomes were similar at time of discharge, 90 days, and 12 months postoperatively (all p>.05). TFAR allowed for an increase in total lumbar lordosis of 16.1° and in lumbar lordosis between L4 and S1 of 16.3° at discharge, which was maintained during follow-up. In both the uni- and multivariable models, patients undergoing TFAR were as likely as patients undergoing standard TLIF to experience any AE (adjusted OR 0.78, 95% CI 0.21–2.94), any reoperation (aOR 0.46, 95% CI 0.11–1.90) or excellent/good clinical outcome at 12 months (aOR 2.01, 95% CI 0.52–7.74). Conclusions: The TFAR technique has a safety profile which is comparable to the standard TLIF procedure, but it allows for a greater restoration of lumbar lordosis at L4-S1. We suggest considering the TFAR technique in selected patients with sagittal imbalance and mobile segments for restoration of lumbar lordosis.

Published in North American Spine Society Journal

ISSN: 2666-5484 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery; Medicine: Internal medicine: Neurosciences. Biological psychiatry. Neuropsychiatry: Neurology. Diseases of the nervous system
Website: https://www.journals.elsevier.com/north-american-spine-society-journal-nassj/

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