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International Orthopaedics

, Volume 43, Issue 4, pp 883–889 | Cite as

What every spine surgeon should know about transforaminal lumbar interbody fusion surgery for herniated discs

  • Mehmet Akif Çaçan
  • Bekir Yavuz UçarEmail author
Original Paper

Abstract

Purpose

The aim of this study is to report our experiences on managing large lumbar disc herniations with several symptoms by surgery with transforaminal lumbar interbody fusion (TLIF) and to shed light for spine surgeons about TLIF surgery.

Methods

We retrospectively evaluated our database of patients with various lumbar spine pathologies who underwent TLIF surgery from 2014 to 2017. We separated 18 patients who had been operated on for extruded disc herniation, which causes severe pain and radicular symptoms. The pain was quantified by visual analog scores (VAS). The disability status were pre-operatively and post-operatively evaluated by the Oswestry Disability Index (ODI). We evaluated the patients for at least two years. Interbody fusion was detected by routine radiographs at six, 12, and 24 months after surgery.

Results

An ODI outcomes analysis demonstrated a statistically significant improvement in the six and 24-month mean scores compared with the pre-operative scores on the same scales. Patients’ mobility improved significantly after surgery, as indicated by the decrease in the Oswestry Disability Index from 72 to 23 over two years (p < 0.001). Pain rapidly decreased in all patients and continued to decrease at the time of the latest follow-up. The mean pre-operative VAS scores for pain was 8.8; it had improved to 2.4 after surgery (p < 0.05). Within the follow-up period of two years, the ascertained mean VAS declined from 8.8 to 1.4 (p < 0.001). The average disc space height at the herniated levels was fairly well maintained. No patient had evidence of implant failure. Interbody fusion was graded as definitely solid in 100% of cases two years post-operatively. One patient displayed a superficial wound infection. Following appropriate debridement and antibiotics, the wound healed without sequelae. No major complications were observed, including permanent neurological deficit, pulmonary embolism, peri-operative cardiac event, or death.

Conclusions

The findings of our study and those in the literature showed that primary herniated disc patients with radicular and chronic low back pain, degenerative changes, bi-radicular symptoms, and instability are required to have fusion after a discectomy. Being a heavy-duty worker is also a criterion for fusion surgery. TLIF is performed by a unilateral approach preserving the interlaminar surface on the contralateral side, which can be used as a site for additional fusion. As an effective results TLIF procedure should be chosen for fusion surgery.

Keywords

Lumbar disc hernia Transforaminal lumbar interbody fusion Low back pain Radicular symptom 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

References

  1. 1.
    Resnick DK, Choudhri TF, Dailey AT et al (2005) Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy. J Neurosurg Spine 2:673–678CrossRefGoogle Scholar
  2. 2.
    Harms J, Jeszenszky D (1998) The unilateral transforaminal approach for posterior lumbar interbody fusion. Orthop Traumatol 6:88–99Google Scholar
  3. 3.
    Mobbs RJ, Phan K, Malham G et al (2015) Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg 1(1):2–18Google Scholar
  4. 4.
    Vaughan PA, Malcolm BW, Maistelli GL (1988) Results of L4–L5 disc excision alone versus disc excision and fusion. Spine 13:690–695CrossRefGoogle Scholar
  5. 5.
    Takeshima T, Kambara K, Miyata S et al (2000) Clinical and radiographic evaluation of disc excision for lumbar disc herniation with and without posterolateral fusion. Spine 25:450–456CrossRefGoogle Scholar
  6. 6.
    Satoh I, Yonenobu K, Hosono N et al (2006) Indication of posterior lumbar interbody fusion for lumbar disc herniation. J Spinal Disord Tech 19:104–108CrossRefGoogle Scholar
  7. 7.
    Gertzbein SD, Hollopeter M, Hall SD (1998) Analysis of circumferential lumbar fusion outcome in the treatment of degenerative disc disease of lumbar spine. J Spinal Disord 11:472–478CrossRefGoogle Scholar
  8. 8.
    Kotilainen E (1998) Long-term outcome of suffering from clinical instability after microsurgical treatment of lumbar disc herniation. Acta Neurochir 140:120–125CrossRefGoogle Scholar
  9. 9.
    Salenius P, Laurent LE (1977) Results of operative treatment of lumbar disc herniation. A survey of 886 patients. Acta Orthop Scand 48:630–634CrossRefGoogle Scholar
  10. 10.
    Overdevest GM, Peul WC, Brand R et al (2017) Tubular discectomy versus conventional microdiscectomy for the treatment of lumbar disc herniation: long-term results of a randomised controlled trial. J Neurol Neurosurg Psychiatry 88(12):1008–1016CrossRefGoogle Scholar
  11. 11.
    Loupasis GA, Stamos K, Katonis PG et al (1999) Seven- to 20-year outcome of lumbar discectomy. Spine 24:2313–2317CrossRefGoogle Scholar
  12. 12.
    Naylor A (1974) Late results of laminectomy for lumbar disc prolapse. A review after ten to twenty-five years. J Bone Joint Surg (Br) 56:17–29Google Scholar
  13. 13.
    O’Sullivan MG, Connolly AE, Buckley TF (1990) Recurrent lumbar disc protrusion. Br J Neurosurg 4:319–325CrossRefGoogle Scholar
  14. 14.
    Thome C, Barth M, Scharf J et al (2005) Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study. J Neurosurg Spine 2:271–278CrossRefGoogle Scholar
  15. 15.
    Eie N (1978) Comparison of the results in patients operated upon for ruptured lumbar discs with and without spinal fusion. Acta Neurochir 41:107–113CrossRefGoogle Scholar
  16. 16.
    Swartz KR, Trost GR (2003) Recurrent lumbar disc herniation. Neurosurg Focus 15:E10CrossRefGoogle Scholar
  17. 17.
    Cinotti G, Gumina S, Giannicola G et al (1999) Contralateral recurrent lumbar disc herniation: results of discectomy compared with those in primary herniation. Spine 24:800–806CrossRefGoogle Scholar
  18. 18.
    Carragee EJ, Han MY, Suen PW et al (2003) Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am 85-A:102–108CrossRefGoogle Scholar
  19. 19.
    Suk KS, Lee HM, Moon SH et al (2001) Recurrent lumbar disc herniation: results of operative management. Spine 26:672–676CrossRefGoogle Scholar
  20. 20.
    Barth M, Weiss C, Thome C (2008) Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 1-evaluation of clinical outcome. Spine 33:265–272CrossRefGoogle Scholar
  21. 21.
    Watters WC, McGirt MJ (2009) An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine J 9:240–257CrossRefGoogle Scholar
  22. 22.
    Matsunaga S, Sakou T, Taketomi E (1993) Comparison of operative results of lumbar disc herniation in manual laborers and athletes. Spine 18:2222–2226CrossRefGoogle Scholar
  23. 23.
    Oxland TR, Lund T (2000) Biomechanics of stand-alone cages and cages in combination with posterior fixation: a literature review. Eur Spine J 9:95–101CrossRefGoogle Scholar
  24. 24.
    Niemeyer T, Halm H, Hackenberg L et al (2006) Post-discectomy syndrome treated with lumbar interbody fusion. Int Orthop 30(3):163–166CrossRefGoogle Scholar
  25. 25.
    Jacquot F, Gastambide D (2013) Percutaneous endoscopic transforaminal lumbar interbody fusion: is it worth it? Int Orthop 37(8):1507–1510CrossRefGoogle Scholar
  26. 26.
    Schizas C, Tzinieris N, Tsiridis E et al (2009) Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience. Int Orthop 33(6):1683–1688CrossRefGoogle Scholar
  27. 27.
    Hu W, Tang J, Wu X et al (2016) Minimally invasive versus open transforaminal lumbar fusion: a systematic review of complications. Int Orthop 40(9):1883–1890CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Orthopaedics and Spine SurgeryIstanbul Medipol University Medical School Medipol Mega Hospital ComplexBagcilarTurkey

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