• Adewale Bakare, Anthony M Alvarado, Vicente Coelho, Jesus R Varela, Gibson J Reine, Jacob Mazza, FontesRicardo B VRBVDepartment of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA., Harel Deutsch, John E O'Toole, and Richard G Fessler.
• Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA. Electronic address: adewale_a_bakare@rush.edu.
• World Neurosurg. 2024 Oct 1; 190: e109e120e109-e120.

ObjectiveThis study evaluates the impact of L4-L5 minimally invasive surgery (MIS)- transforaminal lumbar interbody fusion (TLIF) on adjacent-level parameters.MethodsThis is a retrospective study performed on consecutive patients between January 2015 and December 2019. The index- and adjacent-level segmental lordosis (SL) and disc angle (DA) were measured. Patient-reported outcomes (PROs) were collected preoperatively and at 3-24 months postoperatively. Factors influencing changes in adjacent-level parameters and the occurrence of adjacent segment degeneration (ASDeg) were assessed.ResultsA total of 117 adult patients, averaging 65.5 years of age and slight preponderance of female (56.4%), were analyzed. L4-L5 SL decreased at 2 years (P < 0.05), but L4-L5 DA significantly increased at all timepoints (P < 0.05). While L3-L4 SL and DA significantly decreased at all timepoints (P < 0.05), L5-S1 SL decreased at 3 and 12 months (P < 0.05) and L5-S1 DA only significantly decreased at 2 years (P < 0.05). All PROs improved significantly (P < 0.0001). The ASDeg rate was 19.7% at 2.2 years. Cephalad and caudal ASDeg rates were 12.0% and 10.3%, respectively. Eight patients (6.8%) required adjacent-level reoperations, mainly at L3-L4 (6 cases). The use of expandable cage significantly reduced the odds of caudal ASDeg (OR 0.15, P = 0.037), but had no significant effect on cephalad ASDeg.ConclusionsL4-L5 MIS-TLIF had a more consistent effect on L3-L4 than L5-S1. Although adjacent-level SL and DA decreased over time, their association with ASDeg appears limited, suggesting a multifactorial etiology. L4-L5 MIS-TLIF provides demonstrable clinical benefits with lasting PRO improvements and low adjacent-level reoperations.Copyright © 2024 Elsevier Inc. All rights reserved.

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