On-line version ISSN 2309-8309
SA orthop. j. vol.8 n.1 Pretoria Jan. 2009
MJD JacobsohnI; RN DunnII
IMBChB, FCS(Neuro)SA; AOSpine fellow, Spinal Surgery Unit, Division of Orthopaedics Surgery, Groote Schuur Hospital, Cape Town
IIMBChB (UCT), FCS(SA)Orth, MMed(Orth); Head: Spinal Surgery Unit, Division of Orthopaedics Surgery, Groote Schuur Hospital, Cape Town
AIM: To assess the complications and outcome of patients who underwent transforaminal lumbar interbody fusion (TLIF) with an interbody cage.
METHODS: Fifty-two consecutive patients were reviewed retrospectively. Clinical and radiological data were collected and analysed. Thirty-three female and 19 male patients underwent the procedure with a mean age of 45.7 years (12-76 years). Eight cases were revision surgery.
The primary pathology was a lytic listhesis in 20 patients, degenerative disc disease in 17, adjacent segment disease following a previous fusion in eight, degenerative listhesis in four, a congenital abnormality (L5 hemivertebrae and segmentation failure L2-4) in two, and a neuromuscular scoliosis in one patient.
The mean blood loss was 610 ml and mean operative time 170 minutes. Mean stay in ICU or high care was 1 day, and mean hospital stay was 7.8 days.
All patients operated since 2005 were evaluated pre- and post-op using the following scoring systems: EQ 5D, Visual Analogue Scale (VAS), Roland Morris scale and Oswestry Disability Index (ODI).
RESULTS: There were no intra-operative complications. One patient developed a cauda equina syndrome 48 hours postoperatively when he was mobilised. This resolved completely following evacuation of the haematoma. In one case there was instrumentation failure with a rod screw disarticulation which led to failure of the posterior construct. There were statistically significant improvements in all clinical scores except the EQ 5D.
Fusion could be assessed in 47 patients. Anterior interbody fusion was achieved in 95.3% of cases and posterior lateral fusion was achieved in 83.7%.
CONCLUSION: Transforaminal lumbar interbody fusion is a safe and effective option to achieve circumferential fusion. It is technically challenging and the surgeon needs to be proficient in the technique to avoid catastrophic complications. Clinical scoring confirmed that our patients did benefit significantly in terms of pain and overall health status.
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Dr RN Dunn
Department of Orthopaedic Surgery
Groote Schuur Hospital
Tel: (021) 404-5387; Fax: 086 6715 294
This article was submitted to an ethical committee for approval. The content of this article is the sole work of the authors. No benefits of any form have been derived from any commercial party related directly or indirectly to the subject of this article.