Transforaminal lumbar interbody fusion using one diagonal fusion cage with unilateral pedicle screw fixation for treatment of massive lumbar disc herniation
| Autor: | Kai Zhang, Jie Zhao, Changqing Zhao, Wei Ding |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
musculoskeletal diseases
medicine.medical_specialty arthrodesis Decompression medicine.medical_treatment Arthrodesis spine mesh:Spinal column mesh:arthrodesis herniation unilateral pedicle screw fixation 03 medical and health sciences 0302 clinical medicine Lumbar lumbar disc lcsh:Orthopedic surgery bone screws Discectomy medicine Orthopedics and Sports Medicine transforaminal interbody fusion MeSH terms: Spinal column mesh:bone screws 030212 general & internal medicine mesh:herniation disc business.industry large disc herniation mesh:disc Spinal column mesh:spine Oswestry Disability Index Surgery lcsh:RD701-811 Orthopedic surgery Bi-radicular involvement transforaminal interbody fusion Original Article business 030217 neurology & neurosurgery Lumbosacral joint |
| Zdroj: | Indian Journal of Orthopaedics Indian Journal of Orthopaedics, Vol 50, Iss 5, Pp 473-478 (2016) |
| ISSN: | 1998-3727 0019-5413 |
| Popis: | Background: Large lumbar or lumbosacral (LS) disc herniations usually expand from the paramedian space to the neuroforamen and compress both the transversing (lower) and the exiting (upper) nerve roots, thus leading to bi-radicular symptoms. Bi-radicular involvement is a statistically significant risk factor for poor outcome in patients presenting with far lateral or foraminal disc herniation after facet preserving microdecompression. There is evidence showing that patients suffering from large lumbar disc herniations treated with interbody fusion have significant superior results in comparison with those who received a simple discectomy. We report our experiences on managing large LS disc herniation with bi-radicular symptoms by transforaminal lumbar interbody fusion (TLIF) using one diagonal fusion cage with unilateral pedicle screw/rod fixation. Materials and Methods: Twenty-three patients who suffered from single level lumbar or LS disc herniation with bi-radicular symptoms treated with unilateral decompression and TLIF using one diagonal fusion cage with ipsilateral pedicle screw/rod fixation operated between January 2005 and December 2009, were included in this study. Operation time and blood loss were recorded. The pain and disability status were pre- and postoperatively evaluated by the visual analog score (VAS) and Oswestry Disability Index (ODI). Interbody bony fusion was detected by routine radiographs and computed tomography scan. Adjacent segment degeneration was detected by routine radiographs and magnetic resonance imaging examination. Overall outcomes were categorized according to modified Macnab classification. Results: The patients were followed up for an average of 44.7 months. Pain relief in the VAS and improvement of the ODI were significant after surgery and at final followup. No severe complications occurred during hospital stay. Interbody bony fusion was achieved in every case. No cage retropulsion was observed, while 3 cases experienced cage subsidence. Adjacent segment degeneration occurred at 3 discs cephalic to the fusion segment at followup. No patients underwent revised surgery. Overall outcome was excellent in 5 patients (21.7%), good in 13 (56.5%), fine in 4 (17.5%), and poor in 1 (4.3%). Conclusions: TLIF using one cage with ipsilateral pedicle screw/rod fixation is an effective treatment option for massive lumbar or LS disc herniation with bi-radicular involvement. |
| Databáze: | OpenAIRE |
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