Transforaminal lumbar interbody graft placement using an articulating delivery arm facilitates increased segmental lordosis with superior anterior and midline graft placement.
OBJECTIVE
Transforaminal lumbar interbody fusion (TLIF) is a frequently performed method of lumbar arthrodesis in patients failing medical management of back and leg pain. Accurate placement of the interbody graft and restoration of lordosis has been shown to be crucial when performing lumbar fusion procedures. We performed a single-surgeon, prospective, randomized study to determine whether a novel articulating versus traditional straight graft delivery arm system allows for superior graft placement and increased lordosis for single-level TLIF.


METHODS
Thirty consecutive patients undergoing single-level TLIF were included and prospectively randomized to one of the 2 groups (articulated vs. straight delivery arm system). Three radiographic characteristics were evaluated at 6-week follow-up: (1) degree of segmental lumbar lordosis at the fused level; (2) the percent anterior location of the interbody graft in disk space; and (3) the distance (mm) off midline of the interbody graft placement.


RESULTS
Randomization yielded 16 patients in the articulated delivery arm cohort and 14 in the straight delivery arm cohort. The articulating delivery arm system yielded an average of 14.7-degree segmental lordosis at fused level, 35% anterior location, and 3.6 mm off midline. The straight delivery arm system yielded an average of 10.7-degree segmental lordosis at fused level, 46% anterior location, and 7.0 mm off midline. All 3 comparisons were statistically significant (P<0.05).


CONCLUSIONS
The study suggests that an articulating delivery arm system facilitates superior anterior and midline TLIF graft placement allowing for increased segmental lordosis compared with a traditional straight delivery arm system.
Departments of *Neurosurgery †Orthopedic Surgery, Spinal Column Surgical Quality and Outcomes Laboratory, Vanderbilt University Medical Center, Nashville, TN.
David N
DN
Shau
Scott L
SL
Parker
Stephen K
SK
Mendenhall
Scott L
SL
Zuckerman
Saniya S
SS
Godil
Clinton J
CJ
Devin
Matthew J
MJ
McGirt
D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D005539:Foramen Magnum / Q000601:surgery*; D006801:Humans; D008141:Lordosis / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation* / Q000379:methods*; D010146:Pain / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D012445:Sacrococcygeal Region / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods; D013525:Surgical Instruments; D055815:Young Adult