Universität zu Köln

Telentschak, Sergej ORCID: 0000-0001-9545-3990, Fruechtl, Eva, Perrech, Moritz, Lenschow, Moritz ORCID: 0000-0003-0788-4681, von Spreckelsen, Niklas ORCID: 0000-0002-9873-1711, Czybulka, Dierk-Marko, Goldbrunner, Roland ORCID: 0000-0002-1927-0022 and Neuschmelting, Volker ORCID: 0000-0001-7527-6990 (2025). Sagittal Alignment Correction in Single-Level Minimally Invasive Transforaminal Interbody Fusion with Unilateral vs. Bilateral Facetectomy. Journal of Clinical Medicine, 14 (21). MDPI. ISSN 2077-0383

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Abstract

[Artikel-Nr.: 7595] Objective: Bilateral facetectomy (BF) within minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) remains debated regarding its advantages over unilateral facetectomy (UF) in restoring segmental lordosis, addressing spondylolisthesis and decompressing both neural foramina. The evidence is limited. We sought to determine the benefits of contralateral facetectomy on radiographic and clinical outcomes. Methods: We conducted a single-center retrospective analysis on patients with lumbar degenerative disease who underwent single-level percutaneous instrumentation and MI-TLIF with either UF or BF. Plain radiographs, CT and MRI were utilized for comparative radiographic analysis. Various intraoperative and clinical parameters were evaluated to assess surgical effort and clinical outcomes. Results: We included 81 UF and 23 BF cases; complete radiological data were available for 27 and 13 patients, respectively. Both techniques demonstrated a comparable increase in segmental lordosis (UF 2.1° ± 5.3° vs. BF 4.3° ± 5.4°, p > 0.1), which is below the study’s minimum detectable effect (MDE ≈ 5.1° at 80% power). Spondylolisthesis reduction was similar, with UF achieving a mean of 2.8 ± 2.2 mm and BF 2.4 ± 1.9 mm (p > 0.1). Mean posterior disc height did not differ significantly between groups (p > 0.1). The mean intraoperative blood loss was significantly higher with BF (803 ± 347 mL) compared to UF (437 ± 207 mL, p < 0.001). The mean duration of surgery was significantly longer for BF (240 ± 48 min) compared to UF (197 ± 37 min, p = 0.001). Conclusions: This study found no evidence of a large advantage of BF over UF in restoring segmental lordosis, spondylolisthesis and posterior disc height in monosegmental MI-TLIF surgery. Given the higher blood loss and longer operative time observed with BF, its use should be selective for specific indications.

Item Type:	Article
Creators:	Creators Email ORCID ORCID Put Code Telentschak, Sergej UNSPECIFIED https://orcid.org/0000-0001-9545-3990 UNSPECIFIED Fruechtl, Eva UNSPECIFIED UNSPECIFIED UNSPECIFIED Perrech, Moritz UNSPECIFIED UNSPECIFIED UNSPECIFIED Lenschow, Moritz UNSPECIFIED https://orcid.org/0000-0003-0788-4681 UNSPECIFIED von Spreckelsen, Niklas UNSPECIFIED https://orcid.org/0000-0002-9873-1711 UNSPECIFIED Czybulka, Dierk-Marko UNSPECIFIED UNSPECIFIED UNSPECIFIED Goldbrunner, Roland UNSPECIFIED https://orcid.org/0000-0002-1927-0022 UNSPECIFIED Neuschmelting, Volker UNSPECIFIED https://orcid.org/0000-0001-7527-6990 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-800722
Identification Number:	10.3390/jcm14217595
Journal or Publication Title:	Journal of Clinical Medicine
Volume:	14
Number:	21
Number of Pages:	14
Date:	26 October 2025
Publisher:	MDPI
ISSN:	2077-0383
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Neurochirurgie > Klinik für Allgemeine Neurochirurgie
Subjects:	Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language transforaminal lumbar interbody fusion (TLIF) ; minimally invasive surgery (MIS) ; unilateral facetectomy (UF) ; bilateral facetectomy (BF) ; segmental lordosis English
['eprint_fieldname_oa_funders' not defined]:	Publikationsfonds UzK
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/80072