Medical Student/ Research Assistant
Rohan Jha SB, Joshua I. Chalif MD PhD, Alexander G. Yearley BA, Eric Chalif MD, Hasan A. Zaidi MD
Hasan A. Zaidi MD
Radiographic outcome measures after spine deformity surgery have been shown to correlate with patient disability and quality of life. The expected post-operative changes in radiographic alignment over time remain poorly defined in uncomplicated patients. We identified a retrospective cohort of 114 patients treated with a TLIF for degenerative scoliosis between 2018 and 2022. Patients who completed a primary or revision procedure with no evidence of instrument failure, proximal junctional kyphosis, or proximal junctional failure at last follow-up were included. Thirty-nine patients (mean age 62.6 ± 8.7) had sufficient imaging to meet inclusion criteria: 23 underwent an uncomplicated primary TLIF (Primary) and 16 an uncomplicated revision procedure (Revision). Patients in the Primary group experienced a durable improvement in thoracolumbar Cobb angle (-24.6° ± 15.0°), sagittal vertical axis (-3.8 ± 3.7 cm), thoracic kyphosis (9.8° ± 12.8°), pelvic incidence (PI) (-10.8° ± 11.8°), and PI/lumbar lordosis (LL) mismatch (-19.2° ± 19.1°) through the first year of follow-up. In the Revision group, at 1-year follow-up, all measures of spinopelvic alignment except pelvic incidence and PI/LL mismatch had reverted to pre-operative levels. Thoracolumbar Cobb angle decreased to a significantly greater degree (p = 0.001) in the Primary group compared to the Revision group.
After surgery for curved spines, the way we measure the results using X-rays can tell us how well patients can move and live comfortably. But we’re not sure how the spine’s alignment changes naturally over time in patients without complications. We wanted to explain how the spine’s alignment changes over time in patients who had surgery to fix their curved spines using a specific method called transforaminal lumbar interbody fusion (TLIF).
We focused on 39 patients who fit our criteria. In one group, 23 people had a simple surgery for the first time (Primary), and in another group, 16 people had a simple surgery after an earlier surgery (Revision). People in the first group saw better alignment in their spines in the first year after surgery. But in the second group, after a year, their spine alignment went back to how it was before the surgery. The first group’s spine alignment improved more than the second group’s.
We learned how the spine alignment improves after a simple surgery in patients without complications. The results last for a year. For people who have surgery again, there’s some improvement in their spine alignment, but it’s not as much.