May 08, 2017
1 min read

Presenter discusses factors that impact sagittal balance after TLIF

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Inherent lordosis of the cage, an expandable nature, anterior position of the cage and compression of pedicle screws impacted the postoperative sagittal balance of patients who underwent transforaminal lumbar interbody fusion, according to a presenter at the American Association of Neurological Surgeons Annual Scientific Meeting.

“[It] is important [that] while doing every [transforaminal lumbar interbody fusion] TLIF that the surgeon be aware of the person’s regional and global sagittal balance, because if he is not aware of this, he can inadvertently [create] kyphosis or lead to flat back syndrome,” Karthik Madhavan, MD, neurosurgery spine resident and fellow at the University of Miami Health System, Miller School of Medicine, told

He added, “So for these patients who undergo TLIF — either one, two or even more number levels — if you do not correct the sagittal balance and restore the optimal curve to the lumbar lordosis, then we will end up giving them flat back. It is important that everybody is aware of these parameters of how to calculate the optimal lumbar lordosis based on the pelvic incidence and other parameters.”

In their Stewart B. Dunsker, MD, Award-winning research, Madhavan and colleagues retrospectively reviewed 730 patients who underwent TLIF at more than 1,000 levels. According to a press release, changes in the disc height, lumbar lordosis, pelvic incidence, pelvic tilt and sacral slope were assessed with standing X-rays. Investigators also assessed the reoperation rate.

According to the release, investigators found 90 patients with kyphosis. Of these, 45% had restoration of their lordosis. There were 57% of patients with normal lordosis who developed kyphosis after surgery. Investigators found postoperatively 57% of patients had a high pelvic tilt, 8.5% had high sacral slope and 24% had a high pelvic incidence. In addition, they found 32.1% of patients with high pelvic tilt and 60% of patients with a high sacral slope were successfully corrected with TLIF; however, patients with a high pelvic incidence remained unchanged. There was a 4.1% rate of reoperation due to reasons such as adjacent segment disease and pseudoarthrosis. – by Monica Jaramillo


Madhavan K, et al. Assessment of saggital balance following TLIF: Are we kyphosing the lumbar spine? Presented at: American Association of Neurological Surgeons Annual Scientific Meeting; April 22-26, 2017; Los Angeles.

Disclosures: Madhavan reports no relevant financial disclosures.