[Correction of kyphotic fixed lumbar segments and hypolordosis with the transforaminal lumbar interbody fusion technique].

OBJECTIVE

Correction of a segmental or global lumbar hypolordosis to improve a sagittal imbalance.

INDICATIONS: Lumbar segments fixed in kyphosis; degenerative or posttraumatic hypolordotic deformity of the lumbar spine with sagittal imbalance.

CONTRAINDICATIONS: Bechterew disease; extended adhesions in the retroperitoneum.

SURGICAL TECHNIQUE: Segmental correction of a kyphotic fixed segment using a unilateral transforaminal approach to release the annulus and anterior longitudinal ligament. With an additional posterior V‑shaped osteotomy, a segmental correction of more than 20° could be achieved to improve a global sagittal imbalance.

POSTOPERATIVE MANAGEMENT: Back-friendly mobilisation starting the first day after surgery with support of a physiotherapist. No sports for 3-4 months.

RESULTS

In all, 25 patients with 33 kyphotic fixed lumbar segments were treated using a complete anterior release of the annulus and anterior longitudinal ligament via a unilateral transforaminal approach. This enabled a lordosizing correction of the segment between 5° and 29° (mean 11.4°) without any neurological or vascular complications. A total of 10 patients treated with an additional posterior osteotomy were corrected 14-29° (mean 19°). There was a loss of reduction of the lordotic correction (mean 1°; range 0-3°) in the X‑ray control at a minimum follow-up of 6 months (range 6-33 months).