versión On-line ISSN 2309-8309
SA orthop. j. vol.8 no.1 Pretoria ene. 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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1. Humphreys SC, Hodges SD, Patwondhan AG, Eck JC, Murphy RB, Covington LA. Comparisons of posterior and transforaminal approaches to lumbar interbody fusion. Spine 2001 March 1;26(5):567-71. [ Links ]
2. Potter BK, Freedman BA, Verwiebe E, Hall JM, Polly DW, Kuklo T. Transforaminal lumbar interbody fusion: Clinical and radiographic results and complications in 100 consecutive patients. Journal Spinal Disorders Tech 2005;18:337-46. [ Links ]
3. Weiner B, Nguyen H, Hazard S. Transforaminal lumbar interbody fusion: An independent assessment of outcomes in a difficult patient population. Med Sci Monit 2006;12(3):99-102. [ Links ]
4. Rosenberg MS, Mummaneni PV. Transforaminal lumbar interbody fusion technique, complications and early results. Neurosurgery 2001 March;48(3):569-74. [ Links ]
5. Salehi SA, Tawk R, Ganju A, Lallorca F, Liu JC, Ondra SL. Transforaminal lumbar interbody fusion: Surgical technique and results in 24 patients. Neurosurgery 2004 February;54(2):368-74. [ Links ]
6. Wilson-McDonald J, Fairbank J, Frost H, Yu LM, Barker K, Collins R, Campbell H, Spine Stabilization Trial Group. The MRC spine stabilization trial: surgical methods, outcomes, costs, and complications of surgical stabilization. Spine 2008 Oct 1;33(21):2334-40. [ Links ]
7. Zdeblick TA. A prospective randomized study of lumbar fusion: Preliminary results. Spine 1993 June 15;18(8):983-91. [ Links ]
8. France JC, Norman TL, Santrock RD, McGrath B, Simon BJ. Randomised prospective study of posterolateral fusion: Outcome with and without pedicle screw instrumentation. Spine 1999 March 15;24(6):553-60. [ Links ]
9. Kanyana M, Cunningham BW, Sefter JC, Goldstein JA, Stewart G, Kaneda K. Does spinal instrumentation influence healing process of posterolateral fusion? An in vivo animal model. Spine 1999 June 1;24(11):1058-65. [ Links ]
10. Wang JC, Mummaneni PV, McAfee PC, Haid RW. Current treatment strategies for the painful lumbar motion segment: Posterolateral fusion vs. interbody fusion. Spine 2005 Aug 15;30(16 suppl):S33-43. [ Links ]
11. Hsieh PC, Koski TR, O'Shaughnessy BA, Sugrue P, Salehi S, Ondra S, Liu JC. Anterior lumbar interbody fusion in comparison with transforaminal interbody fusion: Implications for restoration of foraminal height, local disc angle, lumbar lordosis and sagittal balance. Journal of Neurosurgery Spine 2007;7(4):379-86. [ Links ]
12. Madan SS, Boeree NR. Outcome of posterior lumbar interbody fusion vs posterior lateral fusion for spondylolytic spondylolisthesis. Spine 2002 Jul 15; 27(14):1536-42. [ Links ]
13. Kulkarni SS, Lowery GL, Ross RE, Ravi Sankar K, Lykomitros V. Arterial complications following anterior lumbar interbody fusion: report of 8 cases. Eur Spine Journal 2003 Feb;12(1):55-6. [ Links ]
14. Whitecloud TS 3rd, Roesch WW, Ricciardi JE. Transforaminal vs Ant-Post interbody fusion on lumbar spine: a financial analysis. Journal Spinal Disorders 2001 April;14(2):100-3. [ Links ]
15. Gelbe DE, Lenke LG, Bridwell KH, Blanke K, McEnery KW. An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine 1995 Jun 15;20(12):1351-8. [ Links ]
16. Papadoulos S, Konstantinou D, Kourea HP, Kritikos N, Haftouras N, Tsolakis JA. Vascular injury complicating lumbar disc surgery. A systematic review. Eur J Vasc Endovasc Surg 2002;24:189-195. [ Links ]
17. McCord DH, Cunningham BW, Shono Y, Myers JJ, McAfee PC. Biomechanical analysis of lumbosacral fixation. Spine 1992 Aug 17;8(suppl): S235-43. [ Links ]
18. Kornblat MD, Casey MP, Jacobs RR. Internal fixation in lumbosacral spine fusion: A biomechanical and clinical study. Clin Orthop 1986 Feb;203:141-50. [ Links ]
19. Fritzell P, Hagg O, Wessberg P, Nordwall A. Swedish Lumbar Spine Study group. 2001 Volvo award winner in clinical studies. Lumbar fusion vs non-surgical treatment for chronic low back pain: a multicentre randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine 2001 Dec1; 26(23):2521-32. Discussion p2532-4. [ Links ]
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.