Quantitative Assessment of Postoperative Lumbar Morphology Using Geometric Morphometrics: Within-Subject Changes Following TLIF and Decompression.
10 affiliations
- 1Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia.
- 2Department of Orthopedic Surgery, Tel Aviv Medical Center, Affiliated with Tel Aviv University, Tel Aviv 6997801, Israel.
- 3Levin Center for Surgical Innovation, Tel Aviv Medical Center, Affiliated with Tel Aviv University, Tel Aviv 6997801, Israel.
- 4Department of Anatomy and Anthropology, Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel.
- 5Dan David Center for Human Evolution and Bio-History Research, Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel.
- 6Department of Physical Education, Faculty of Sciences, Kibbutzim College of Education, Technology and the Arts, Tel Aviv 6250769, Israel.
- 7Centre for Orthopedics and Trauma Research, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia.
- 8Department of Neurosurgery, Spine Unit, Tel Aviv Medical Center, Affiliated with Tel Aviv University, Tel Aviv 6997801, Israel.
- 9Spine Service, Department of Orthopedic Surgery, St. George and Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia.
- 10Spinal Unit, Discipline of Orthopedic Surgery, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
Abstract
Background: Conventional radiographic assessment of postoperative lumbar alignment relies predominantly on Cobb angle measurements, which incompletely characterize global spinal morphology. We evaluated whether geometric morphometrics (GM) provides complementary quantitative information for assessing postoperative lumbar morphology after TLIF and decompression. Methods: Ninety-nine patients (TLIF n = 70; decompression n = 29) underwent landmark-based GM analysis of pre- and post-surgical lateral lumbar radiographs (48 landmarks, L1-S1). Because TLIF and decompression patients were imaged at markedly different postoperative intervals as a matter of routine clinical practice, the primary analyses tested whether each technique's own pre-to-post shape change, adjusted for baseline L1-S1 angle, log centroid size, sex, age, number of operated levels, and degenerative spondylolisthesis, was significant (sign-flip permutation test), along with lordosis change (paired t-test, unadjusted). Cobb analyses assessed global lumbar lordosis (L1-S1) and operated level(s). Results: TLIF showed a significant within-group reduction in global lumbar lordosis at early postoperative imaging (Δ = -3.75°, paired t-test p < 0.001) and a significant, systematic change in overall lumbar shape (sign-flip permutation p < 0.001); decompression showed no significant within-group change in global lordosis (Δ = +0.47°, p = 0.733) or overall shape (p = 0.31), but a small increase in segmental lordosis at the operated level(s) (Δ = +1.44°, p = 0.036) that was not robust to sensitivity analysis. Conclusions: In this retrospective cohort, TLIF was associated with reduced lumbar lordosis and a systematic shape change at early postoperative imaging, while decompression showed preserved global lordosis and a small gain in segmental lordosis at long-term imaging. GM provided a consistent quantitative framework, with strong correlation and level-dependent agreement against manual Cobb measurement, for characterizing these within-technique postoperative changes.
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BibTeX
@article{benady2026quantitative,
title = {{Quantitative Assessment of Postoperative Lumbar Morphology Using Geometric Morphometrics: Within-Subject Changes Following TLIF and Decompression.}},
author = {Amit Benady and Owen Zhou and Amit Hadad and Hila May and Ryan David Quarrington and Afek Ash and Stone Sima and Victor Chen and Morsi Khashan and Ashish Diwan},
journal = {Diagnostics (Basel, Switzerland)},
year = {2026},
month = sep,
doi = {10.3390/diagnostics16193177},
url = {https://europepmc.org/article/MED/42882332},
note = {CC BY},
}
RIS
TY - JOUR
TI - Quantitative Assessment of Postoperative Lumbar Morphology Using Geometric Morphometrics: Within-Subject Changes Following TLIF and Decompression.
AU - Amit Benady
AU - Owen Zhou
AU - Amit Hadad
AU - Hila May
AU - Ryan David Quarrington
AU - Afek Ash
AU - Stone Sima
AU - Victor Chen
AU - Morsi Khashan
AU - Ashish Diwan
PY - 2026
DA - 2026/09/30
JO - Diagnostics (Basel, Switzerland)
DO - 10.3390/diagnostics16193177
UR - https://europepmc.org/article/MED/42882332
AB - Background: Conventional radiographic assessment of postoperative lumbar alignment relies predominantly on Cobb angle measurements, which incompletely characterize global spinal morphology. We evaluated whether geometric morphometrics (GM) provides complementary quantitative information for assessing postoperative lumbar morphology after TLIF and decompression. Methods: Ninety-nine patients (TLIF n = 70; decompression n = 29) underwent landmark-based GM analysis of pre- and post-surgical lateral lumbar radiographs (48 landmarks, L1-S1). Because TLIF and decompression patients were imaged at markedly different postoperative intervals as a matter of routine clinical practice, the primary analyses tested whether each technique's own pre-to-post shape change, adjusted for baseline L1-S1 angle, log centroid size, sex, age, number of operated levels, and degenerative spondylolisthesis, was significant (sign-flip permutation test), along with lordosis change (paired t-test, unadjusted). Cobb analyses assessed global lumbar lordosis (L1-S1) and operated level(s). Results: TLIF showed a significant within-group reduction in global lumbar lordosis at early postoperative imaging (Δ = -3.75°, paired t-test p < 0.001) and a significant, systematic change in overall lumbar shape (sign-flip permutation p < 0.001); decompression showed no significant within-group change in global lordosis (Δ = +0.47°, p = 0.733) or overall shape (p = 0.31), but a small increase in segmental lordosis at the operated level(s) (Δ = +1.44°, p = 0.036) that was not robust to sensitivity analysis. Conclusions: In this retrospective cohort, TLIF was associated with reduced lumbar lordosis and a systematic shape change at early postoperative imaging, while decompression showed preserved global lordosis and a small gain in segmental lordosis at long-term imaging. GM provided a consistent quantitative framework, with strong correlation and level-dependent agreement against manual Cobb measurement, for characterizing these within-technique postoperative changes.
SN - 2075-4418
ER -