Changes in Segmental and Lumbar Lordosis Following Lumbar Interbody Fusion

Study Design: Systematic review and meta-analysis. Objective: To compare radiographic outcomes across lumbar interbody fusion (LIF) techniques, assessing segmental and global lumbar lordosis restoration. Summary of Background Data: LIF is a commonly utilized procedure to treat various spinal conditions, including degenerative pathology and adult spinal deformity. Common approaches include posterior LIF (PLIF), transforaminal LIF (TLIF), anterior LIF (ALIF), oblique LIF (OLIF), and lateral LIF (LLIF). Methods: A systematic review and meta-analysis were carried out using PRISMA guidelines with appropriate MeSH terms. Papers were included based on relevance, number of patients, and a minimum of 1-year radiographic follow-up. Radiographic outcomes included segmental lordosis (SL) and lumbar lordosis (LL). Only papers directly comparing SL restoration between two or more LIF techniques were utilized in the systematic review, while all articles meeting the aforementioned criteria were used in the meta-analysis. Results: Nineteen studies were included in the final systematic review, and 88 papers were included in the meta-analysis. Seven studies in the systematic review showed a significantly higher increase in SL with ALIF versus TLIF, and two showed significantly higher SL gain with ALIF compared with LLIF. When comparing ALIF versus OLIF, one study favored ALIF, while another favored OLIF for SL restoration. OLIF likewise demonstrated superior restoration of SL compared with TLIF. LLIF demonstrated improved SL restoration compared with TLIF in 2 of the 3 studies comparing the 2 procedures. Furthermore, both ALIF and OLIF demonstrated superior LL restoration compared with TLIF in 4 and 3 studies, respectively. The meta-analysis results demonstrated that ALIF provided significantly better restoration of SL than TLIF, LLIF, and OLIF, while TLIF conferred significantly lower SL restoration than ALIF and OLIF. Similarly, LL restoration was significantly reduced with TLIF relative to OLIF and LLIF (all P <0.05). Conclusions: The included studies demonstrated superior SL and LL restoration with ALIF, OLIF, and LLIF compared with TLIF. ALIF improved SL to a greater extent when directly compared with all other interbody techniques.