Unilateral Versus Bilateral Facetectomy and its Effect on Segmental Lordosis and Disc Height in MIS TLIF

Author(s): Jacob Archer, Kathy Flint, Stephen Mendenhall, Jean-Pierre Mobasser

Background: Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) techniques have allowed for improved recovery and other metrics compared to its open counterpart. Our expanding literature has increasingly demonstrated the importance of spinopelvic parameters. One of the concerns with MIS TLIF is that the limited exposure and existing technology make it difficult to restore lumbar lordosis at the degenerative level requiring surgery. We hypothesize that bilateral facetectomy with MIS techniques will allow for increased ability to restore segmental lumbar lordosis versus traditional unilateral facetectomy.

Methods: This is a retrospective chart review of all patients who underwent single level MIS TLIF between 2017 and 2018. We collected baseline characteristics and reviewed operative records to determine whether unilateral or bilateral facetectomies were performed. We used intraoperative CT (O-Arm) sagittal reformatted images to measure segmental lordosis as well as anterior, middle, and posterior disc heights.

Results: Forty patients were identified. Eighteen underwent bilateral facetectomy, and 22 had unilateral facetectomy. We found a significantly increased middle disc height in the bilateral facetectomy group of 3.6 mm vs 2.8 mm in the unilateral group (p=0.04). We also found increased lordosis (4.4 vs. 3.7, respectively) as well as anterior (4.5 vs 3.5) disc height in the bilateral facetectomy group but neither reached statistical significance.

Conclusion: Bilateral facetectomy is a tool that can help achieve maximal lordosis and disc height restoration in MIS TLIF surgery. Benefits besides lordosis and disc height restoration include increased autograft for fusion. Across various papers there seems to be a trend toward greater lordosis and disc height restoration, however most papers including ours have been underpowered to find significance.

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