• Eric Zhao, Takashi Hirase, Andrew G Kim, Jerry Y Du, Troy B Amen, Kasra Araghi, Tejas Subramanian, Robert Kamil, Pratyush Shahi, Mitchell S Fourman, Tomoyuki Asada, Chad Z Simon, Nishtha Singh, Maximilian Korsun, Olivia C Tuma, Joshua Zhang, Amy Z Lu, Eric Mai, Ashley Yeo Eun Kim, Myles R J Allen, Cole Kwas, James E Dowdell, Evan D Sheha, Sheeraz A Qureshi, and Sravisht Iyer.
• Department of Spine Surgery, Hospital for Special Surgery, New York, NY.
• Spine. 2024 May 1; 49 (9): 652660652-660.

Study DesignRetrospective cohort study.Objective(1) To develop a reliable grading system to assess the severity of posterior intervertebral osteophytes and (2) to investigate the impact of posterior intervertebral osteophytes on clinical outcomes after L5-S1 decompression and fusion through anterior lumbar interbody fusion (ALIF) and minimally-invasive transforaminal lumbar interbody fusion (MIS-TLIF).BackgroundThere is limited evidence regarding the clinical implications of posterior lumbar vertebral body osteophytes for ALIF and MIS-TLIF surgeries and there are no established grading systems that define the severity of these posterior lumbar intervertebral osteophytes.Patients And MethodsA retrospective analysis of patients undergoing L5-S1 ALIF or MIS-TLIF was performed. Preoperative and postoperative patient-reported outcome measures of the Oswestry Disability Index (ODI) and leg Visual Analog Scale (VAS) at 2-week, 6-week, 12-week, and 6-month follow-up time points were assessed. Minimal clinically important difference (MCID) for ODI of 14.9 and VAS leg of 2.8 were utilized. Osteophyte grade was based on the ratio of osteophyte length to foraminal width. "High-grade" osteophytes were defined as a maximal osteophyte length >50% of the total foraminal width.ResultsA total of 70 consecutive patients (32 ALIF and 38 MIS-TLIF) were included in the study. There were no significant differences between the two cohorts in patient-reported outcome measures or achievement of MCID for Leg VAS or ODI preoperatively or at any follow-ups. On multivariate analysis, neither the surgical approach nor the presence of high-grade foraminal osteophytes was associated with leg VAS or ODI scores at any follow-up time point. In addition, neither the surgical approach nor the presence of high-grade foraminal osteophytes was associated with the achievement of MCID for leg VAS or ODI at 6 months.ConclusionALIF and MIS-TLIF are both valid options for treating degenerative spine conditions and lumbar radiculopathy, even in the presence of high-grade osteophytes that significantly occupy the intervertebral foramen.Level Of Evidence3.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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