A Radiological Evaluation of Effect of a Single Level Trans-Foraminal Lumbar Interbody Fusion (TLIF) on Lumbar Sagittal Parameters
Bibliographic record
Abstract
Aim To investigate the effect of a primary single level TLIF on the lumbar sagittal profile (segmental lordosis and total lumbar lordosis) comparing pre-operative, intra-operative and post-operative radiographs in patients with lumbar spine degenerative disease. Methods Patients over the age of 16 who underwent a single-level interbody fusion for degenerative stenosis and/or spondylolisthesis without scoliosis between March 2008 and March 2014 were reviewed. Age, gender, surgical level, surgical approach, facetectomy (unilateral vs bilateral) were recorded. Standardized pre and early and 6 month postoperative upright radiographs as well as an intra-operative lateral radiographs were analyzed for the pelvic incidence (PI), segmental lordosis (SL) at the TILF level and total lumbar lordosis (TL). Data analysis was performed after confirming normality using a paired t-test and is presented as mean (SD). p-value < 0.05 was considered significant. Results 69 patients were reviewed. The mean age was 58.6 (13.6) years, 39 males (56.5%), a Wiltse approach was used in 30 (43.5%) while 39 had a midline posterior approach. Segments operated were L2/L3 (1 case), L3/L4 (6), L4/L5 (43), L5/S1 (19) and bilateral facetectomy was performed in 13 (18.8%). SL changed from 15.2° (7.3) preoperatively to 20.4° (7.7) intraoperatively ( p-value < 0.0001) but measured 17.9° (7.2) ( p-value < 0.0001) on early postoperative images and 17.2° (7.3) at 6 months follow up ( p-value= 024). The total improvement in SL at 6 months was 2° (6.7), ( p-value= 0.001). TL change was insignificant on the early postoperative X-rays (48.5° (12.4) to 47.2° (11.3), p-value= 0.37) but significantly increased to 53.1° (11.5) at six months ( p-value < 0.0001) with a total improvement of 4.6° (10) ( p-value= 0.001). The mean pelvic incidence was 59.7° (11.2). The cage subsided in 11 (15.9%) cases and we had no metal work loosening. Conclusion At the level of the TLIF, much of the lordosis achieved intra-operatively is lost once the patient mobilizes. An improvement in the total lumbar lordosis at 6 months following surgery is likely to be due to the decompression component of the surgical intervention.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".