gms | German Medical Science

Objective: The benefit of investing the additional surgical effort in contralateral arthrectomy during minimally invasive TLIF surgery is unclear. We aimed to analyze the impact of bilateral arthrectomy (BA) on restoring segmental sagittal alignment and lordosis compared to unilateral arthrectomy (UA) in degenerative MIS TLIF surgery.

Methods: We retrospectively screened 119 patients with lumbar degenerative disease who underwent single level dorsal percutaneous navigated instrumentation and MIS TLIF surgery between 2017-2021 at our spine center and reviewed their perioperative clinical records. Pre- and postoperative standing radiographs of the spine were compared by Surgimap^®. Statistics were expressed as mean ± standard deviation and differences considered significant when p <0.05.

Results: We could enclose 23 monosegmental MIS TLIF cases who underwent MIS TLIF with BA and 81 with UA with suitable clinical data, including 13 BA patients and 27 UA patients that received suitable pre- and postoperative standing spine radiographs. We found a significant gain of segmental lordosis (2.1° ± 5.3°) and a significant reduction of spondylolisthesis (2.8 ± 2.2mm) from pre- to postoperatively in the UA group as well as in the BA group (4.3° ± 5.4° and 2.4 ± 1.9 mm respectively, each p <0.05), but there was no significant difference between the UA and BA group. The mean intraoperative blood loss was significantly increased in the patients who underwent BA (803 ± 347 ml) compared to the UA patients (437 ± 207 ml, p <0.001) and the mean surgery duration was significantly longer for the BA patients (240 ± 48 min) than in the UA (197 ± 37 min, p = 0.001). No significant difference was found between the two groups regarding demographic and clinical parameters as well as intraoperative adverse events nor early postoperative complications.

Conclusion: Our data on monosegmental MIS TLIF surgery for patients with lumbar degenerative disease and spondylolisthesis demonstrated the additional contralateral arthrectomy to be a safe procedure, but without additional benefit in restoring the segmental sagittal alignment or lordosis compared to unilateral arthrectomy. Due to an increased intraoperative effort and blood loss the indication for BA needs to be set carefully for selected cases, i.e. symptomatic bilateral high grade foraminal stenosis that cannot be sufficiently addressed by unilateral indirect decompression.