Elgafy Hossein, Olson Doug, Liu Jiayong, Lewis Caitlin, Semaan Hassan
Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA,
Eur Spine J. 2015 Apr;24(4):810-6. doi: 10.1007/s00586-014-3726-8. Epub 2014 Dec 20.
To determine the efficacy and safety of transforaminal lumbar interbody fusion (TLIF) for revision lumbar spine surgery in patients with previous laminectomy. The secondary objective was to evaluate the clinical and radiological outcome after such a procedure.
Retrospective case series study. Eighty-two patients were included. There were 48 women (58.5 %) and 34 men (41.5 %) with a mean age of 51 years (range 26-84) at the time of index procedure. The outpatient and inpatient charts were reviewed to identify patients' demographic data, preoperative, perioperative, and postoperative data. The outcome measures were assessed by Oswestry Disability Index (ODI) and visual analog scale (VAS) for back and leg pain. An independent spine surgeon and musculoskeletal radiologist reviewed the imaging studies.
The average operative time was 160 min (range 131-250). The average estimated blood loss was 652 cc (100-1,400 cc). Nineteen patients (23.1 %) required blood transfusion. Five patients (6 %) had dural tear. One patient (1.2 %) had a surgical site infection. Two patients (2.4 %) had thromboembolic events. The average hospital stay was 3.8 days (2-5 days). At a mean follow-up of 28 months, there were statically significant improvement in the ODI and VAS for back and leg pain. None of the patients' radiographs showed hardware failure or pedicle screw loosening and no patient returned to the operating room for pseudarthrosis.
The current study confirmed that TLIF approach in patients with previous laminectomy is effective and safe with good outcomes.
确定经椎间孔腰椎椎体间融合术（TLIF）用于曾行椎板切除术的腰椎翻修手术的疗效和安全性。次要目的是评估该手术后的临床和影像学结果。
回顾性病例系列研究。纳入82例患者。初次手术时，有48例女性（58.5%）和34例男性（41.5%），平均年龄51岁（范围26 - 84岁）。查阅门诊和住院病历以确定患者的人口统计学数据、术前、围手术期和术后数据。通过Oswestry功能障碍指数（ODI）和视觉模拟量表（VAS）评估背部和腿部疼痛的结果指标。一名独立的脊柱外科医生和肌肉骨骼放射科医生对影像学研究进行了评估。
平均手术时间为160分钟（范围131 - 250分钟）。平均估计失血量为652毫升（100 - 1400毫升）。19例患者（23.1%）需要输血。5例患者（6%）发生硬脊膜撕裂。1例患者（1.2%）发生手术部位感染。2例患者（2.4%）发生血栓栓塞事件。平均住院时间为3.8天（2 - 5天）。平均随访28个月时，ODI以及背部和腿部疼痛的VAS有统计学上的显著改善。患者的X线片均未显示内固定失败或椎弓根螺钉松动，且没有患者因假关节形成返回手术室。
本研究证实，TLIF方法用于曾行椎板切除术的患者是有效且安全的，效果良好。
