title: Comparison of Clinical and Radiographic Outcomes in Patients Receiving Single-Level Transforaminal Lumbar Interbody Fusion With Removal of Unilateral or Bilateral Facet Joints.
abstract: METHODS
  A retrospective cohort study.
  
  
  OBJECTIVE
  The objective of this study is to compare the radiographic and clinical outcomes of transforaminal lumbar interbody fusion (TLIF) with bilateral facetectomy (BF) versus unilateral facetectomy (UF).
  
  
  BACKGROUND
  BF is a surgical technique utilized with the intent of creating a greater degree of segmental lordosis than UF alone. However, the clinical benefits of this technique have not been defined. We seek to determine whether a difference exists between bilateral versus UF during TLIF by utilizing both clinical and radiographic outcome measures.
  
  
  METHODS
  The electronic medical records of 57 patients who underwent single-level TLIF with either a UF (n = 28) or BF (n = 29) were reviewed. Clinical outcomes were measured through Patient Health Questionnaire-9 (PHQ-9), Pain Disability Questionnaire (PDQ), EuroQol 5 Dimensions (EQ-5D) Health State, and Quality Adjusted Life Year (QALY). Radiographic parameters including disc height and sagittal balance were measured on plain radiographs at 1 year following operation.
  
  
  RESULTS
  All radiographic parameters showed no significant differences between the UF and BF cohorts. Segmental lordosis increased significantly in both cohorts. However, there was no significant difference in the increase of segmental lordosis between cohorts. Overall lumbar lordosis did not increase significantly in either cohort. Perioperative complications were also similar between cohorts. PDQ and EQ-5D scores improved significantly in both cohorts at 1 year postoperatively. The BF cohort showed a significantly greater improvement in both EQ-5D (0.1 ± 0.2 vs. 0.3 ± 0.2, P = 0.01) and PHQ-9 scores (-0.8 ± 4.6 vs. 4.6 ± 5.2, P = 0.03) than the UF cohort. The PDQ score improved over the minimally clinical important difference (MCID) of 26 in only the BF cohort.
  
  
  CONCLUSIONS
  The findings in the present study demonstrate that BF during single-level TLIF improves clinical outcomes to a greater degree than UF without any notable differences in perioperative complications or radiographic measurements.
  
  
  METHODS
  3.
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, OH.|Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, OH.|Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH.
authors.forename: Erik Y
authors.initials: EY
authors.lastname: Tye
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, OH.|Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, OH.|Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH.
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Alentado
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, OH.|Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, OH.|Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH.
authors.forename: R Douglas
authors.initials: RD
authors.lastname: Orr
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, OH.|Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Steinmetz
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008141:Lordosis / Q000209:etiology*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods; D013168:Spondylolisthesis / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult; D021801:Zygapophyseal Joint / Q000601:surgery*