Comparing Radiographic Outcomes Between Unilateral and Bilateral Facetectomy in Transforaminal Lumbar Interbody Fusions

Introduction: Spine surgeons have historically used transforaminal lumbar interbody fusion (TLIF) to treat degenerative spinal pathologies. This approach, which can be performed in a unilateral or bilateral facetectomy approach, achieves circumferential fusion with less traction and damage to neural structures compared to the standard PLIF. Previous studies have shown comparable clinical and surgical outcomes amongst unilateral and bilateral facetectomies, however, the TLIF procedure itself, overall, offers limitations in restoring adequate lumbar lordosis. Therefore, the objective of this study was to identify whether a unilateral or bilateral facetectomy approach provides better restoration of lumbar lordosis.

Methods: A retrospective review of one- and two-level TLIF procedures at a tertiary care center from 04/2016 to 12/2023 analyzed unilateral and bilateral facetectomies. There were 21 patients included in the study. Variables collected included demographic, clinical, surgical data, and pre-operated and post-operative Cobb angle at the level of fusion. A sample t-test was used to compare the change in Cobb Angle between unilateral and bilateral facetectomy. A p-value of p< 0.05 was used to identify statistical significance.

Results: There was a decrease in the change of the Cobb angle from the pre-operative to post-operative measurements for the unilateral facetectomy cohort of 15 patients (p = 0.79). There was an increase in the change seen in the bilateral facetectomy cohort of 6 patients (p = 0.86). There was o significant difference in the change in the Cobb angle between the unilateral and bilateral facetectomy cohorts (p = 0.74).

Conclusion : This study sought to compare the change in lumbar lordosis between unilateral and bilateral facetectomy approaches in TLIF. The change in lumbar lordosis between unilateral and bilateral facetectomy was comparable, making either approach adequate when considering radiographic parameters and restoring lumbar lordosis.