Special Poster Session 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Evaluating the Combined Effects of Posterior Column Osteotomy and Transforaminal Lumbar Interbody Fusion on Surgical Outcomes: A Comprehensive Retrospective Study (113929)

Ved A Vengsarkar 1 2 , Jialun Chi 2 , Kate S Woods 3 , Hanzhi Yang 2 , Yi Zhang 4 , Jesse Wang 2 , Lawal Labaran 2 , Xudong Li 2
  1. Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
  2. Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
  3. Department of Orthopaedic Surgery, Creighton University School of Medicine, Omaha, NE, USA
  4. Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China

INTRODUCTION

The combination of Transforaminal Lumbar Interbody Fusion (TLIF) and Posterior Column Osteotomy (PCO) has been investigated as a strategy for correcting spinal deformities. For patients at risk of developing kyphosis after a TLIF, incorporating a PCO may serve as a valuable supplementary procedure. However, adding a PCO carries certain risks, including potential instability due to the excision of posterior structures. While these techniques have been integrated to improve outcomes in complex long-segment adult spinal deformities, there is limited literature addressing their effects on short-segment fusions. This study aims to retrospectively analyze single-level TLIF outcomes, comparing cases with and without PCO, to gain insights into the implications of this combined approach.

METHODS

Data was obtained from the PearlDiver multipayer database, identifying patients who underwent primary single-level TLIF from 2010 to 2019. The study included all patients older than 18 years who underwent a single-level TLIF with and without PCO. The control cohort was matched 5:1 to the TLIF with PCO group based on various demographic and clinical factors, including age, sex, and comorbidities. Patients in both groups were evaluated for 90-day medical complications: pneumonia, pulmonary embolism, cerebrovascular accident, deep vein thrombosis, hyponatremia, delirium, myocardial infarction, sepsis, acute kidney injury, and urinary tract infection. 90-day surgical complications include wound complications, surgical site infection, and transfusion. 2-year complications include pseudarthrosis, hardware failure, and an overall 5-year reoperation rate. Reoperations were identified based on any subsequent surgery, including fusion, decompression, and/or revision or removal of instrumentation.

RESULTS

2,637 patients in the national database who underwent TLIF and PCO were paired with 12,976 TLIF-only patients following the match. The PCO group exhibited higher rates of pneumonia (1.8% vs. 1.0%; p = 0.001), pulmonary embolism (0.6% vs. 0.3%; p = 0.014), and sepsis (1.4% vs. 0.8%; p = 0.004) within 90 days postoperatively. Furthermore, the incidence of pseudarthrosis at 2 years was higher in the PCO cohort (3.5% vs. 2.8%; p = 0.042). Over a five-year follow-up period, the cohort of patients who underwent TLIF with PCO was reduced to 1,191, while the control group maintained 5,858 patients. Over a five-year follow-up period, reoperation was necessary for 158 (13.3%) patients in the TLIF with PCO group, compared to 668 (11.4%) in the control group (p < 0.001).

DISCUSSION

This retrospective analysis demonstrates that the integration of PCO with TLIF significantly increases the risk of postoperative complications, particularly pseudarthrosis and the need for revision surgeries. Although PCO is effective for correcting spinal deformities and enhancing lordosis, it introduces biomechanical alterations that may compromise spinal stability. The complexity of PCO contributes to elevated medical complication rates, including pneumonia and pulmonary embolism, which must be carefully weighed against potential benefits. This study underscores the importance of meticulous surgical planning and patient selection. Future research should focus on optimizing surgical techniques and understanding the long-term effects of PCO in TLIF procedures, particularly concerning the type of interbody cage used and its influence on outcomes. This will help refine approaches for improving patient outcomes in complex spinal surgeries.

 

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