[Transforaminal lumbar interbody fusion in the treatment of lumbar intervertebral disc herniation with lumbar instability].

OBJECTIVE

To explore the surgical efficacy of transforaminal lumbar interbody fusion (TLIF) technique in the treatment of lumbar intervertebral disc herniation with lumbar instability.

METHODS

From November 2008 to August 2011, 47 patients of lumbar intervertebral disc herniation underwent TLIF. There were 25 males and 22 females with an average age of 52 years (range: 30 - 68). The preoperative diagnoses included lumber intervertebral disc herniation plus lumbar instability (n = 16); lumbar degenerative spondylolisthesis (n = 9); lumbar spinal stenosis (n = 15) and degenerative lumbar scoliosis (n = 7). A total of 63 levels were fused, including single level (n = 31) and double levels (n = 16). Posterolateral fixation was secured with pedicle screw. Unilateral resections of inferior articular facet of superior vertebra and superior articular facet of inferior vertebra were performed to expose unilateral intervertebral vertebral foramen. Decompression of vertebral canal was expanded to the opposite side if symptoms recurred when never root was decompressed satisfactorily. Finally TLIF was performed routinely. The standard criteria of JOA (Japanese Orthopedic Association) and ODI (Oswestry disability index) were applied for efficacy evaluations. And the intervertebral height and bone fusion were observed radiologically.

RESULTS

All patients underwent surgery smoothly without severe complications. The average follow-up period was 19.6 months (range: 6 - 36). Significant differences existed in JOA score between pre-operation (11.0 ± 2.8) and postoperation (15.4 ± 3.4) (P = 0.01) and ODI score between pre-operation (37.8 ± 4.6) and postoperation (18.8 ± 3.8). At 6.5 months postoperatively, all operated segments achieved fusion and there was no broken screw. There was 1 case of cage dislocation.

CONCLUSION

In select patients of lumbar intervertebral disc herniation with spinal instability, TLIF may be performed easily and safely with fewer complications and total root decompression.