Introduction: Transforaminal lumbar interbody fusion (TLIF) is a workhorse procedure for the spine surgeon. As trends have shifted towards minimally invasive surgery (MIS), the MIS-TLIF has seen increased utilization. At times, surgeons will perform bilateral facetectomies during MIS-TLIF in the hopes of achieving better sagittal alignment. However, it is unknown if this additional osteotomy actually improves spinopelvic parameters. In this study, we compared changes in pre- and postoperative radiographic parameters between patients who underwent bilateral (BL) vs unilateral (UL) facetectomies during single-level MIS-TLIF at L4-5.
Methods: We performed a retrospective chart review of all patients who underwent L4-5 MIS-TLIF between 2015 and 2023. We collected baseline characteristics and reviewed operative records to determine whether UL or BL facetectomies were performed. We collected and analyzed pre- and post-operative standing scoliosis x-rays to compare radiographic parameters.
Results: We identified 52 patients who underwent MIS-TLIF with five different surgeons. There were 34 patients who underwent BL facetectomies and 18 patients who underwent UL facetectomies. In our analysis, there were no statistically significant differences in the changes in spinopelvic parameters, including segmental and lumbar lordosis. However, our analysis did show that the UL facetectomy group had significantly greater postoperative anterior (11.9 vs 9.0mm, p< 0.001) and posterior (6.0 vs 4.7mm, p< 0.001) disc height than the BL group.
Conclusion : There were no significant differences between pre- and postoperative spinopelvic parameters between the two groups. These findings suggest that performing BL versus UL facetectomies during MIS-TLIF does not appear to significantly affect spinopelvic radiographic outcomes.
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