J Neurosurg Spine 43:70–82, 2025
This systematic review and meta-analysis found that single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) generally preserves segmental and overall lumbar lordosis, with preoperative alignment and use of expandable cages predicting postoperative lordosis. Greater segmental lordosis improvement was associated with reduced leg pain, but clinical outcome correlations were otherwise limited.
• Single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) generally preserves or slightly increases segmental and overall lumbar lordosis.
• Meta-analysis of 35 studies (1935 patients) showed significant but modest increases in segmental lordosis (mean +2.2°) and lumbar lordosis (mean +2.8°) postoperatively.
• Preoperative alignment and use of expandable cages are significant predictors of postoperative lordosis change.
• Greater improvement in segmental lordosis was associated with larger reductions in postoperative leg pain, but no strong correlation with other clinical outcomes was found.
• Most included studies were retrospective case series, with high heterogeneity in surgical technique and reporting.
• No significant association was found between facetectomy type, operative bed, or fixation technique and changes in lordosis.
• The main goal of MI-TLIF is neural decompression and fusion, not alignment correction; alternative approaches may be needed for major lordosis restoration.
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