Lumbar Lordosis Correction with Interbody Fusion: Systematic Literature Review and Analysis

Objective: The goal of this study was to conduct an evidence-based quantitative assessment of the correction of lumbar lordosis achieved by each of the 3 principal lumbar interbody fusion techniques: anterior lumbar interbody fusion (ALIF), lateral lumbar interbody fusion (L-LIF), and transforaminal lumbar interbody fusion (TLIF). Methods: A systematic review of the literature was conducted to identify studies containing degrees of correction of lumbar lordosis achieved by ALIF, L-LIF, and TLIF as shown on standing lumbar radiography at least 6 weeks after surgical intervention. Pooled and Forest plot analyses were performed for the studies that met inclusion criteria. Results: For ALIF, 21 studies were identified with mean correction 4.67° (standard deviation [SD] ± 4.24) and median correction 5.20°. Fifteen studies were identified that met criteria for Forest plot analysis with mean correction 4.90° (standard error of the mean [SEM] ± 0.40). For L-LIF, 17 studies were identified with mean correction 4.47° (SD ± 4.80) and median correction 4.00°. Nine studies were identified that met criteria for Forest plot analysis with mean correction 2.91° (SEM ± 0.56). For TLIF, 31 studies were identified with mean correction 3.89° (SD ± 4.33) and median correction 3.50°. Twenty-five studies were identified that met criteria for Forest plot analysis with mean correction 5.33° (SEM ± 0.27). Conclusions: We present the current evidence-based mean correction for each of the 3 principal lumbar interbody fusion techniques based on standing radiographic data.