Transforaminal lumbar interbody fusion in failed back surgery | ||||
| The Egyptian Orthopaedic Journal | ||||
| Volume 47, Issue 3, September 2012, Page 265-270 PDF (519.5 K) | ||||
| DOI: 10.7123/01.EOJ.0000417985.13365.28 | ||||
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| Authors | ||||
| Ali M. Maziad; Figen Aslan; Ezzat M. El-Hawi; Mohamed A. Maziad | ||||
| Abstract | ||||
| Background data Spinal surgery on the lumbar region, particularly neurological decompression procedures, may rapidly relieve disabling symptoms, like sciatic pain and cauda equina syndrome. Many of these procedures require a limited number of specialized surgical equipment; hence they gained popularity worldwide. During the last two decades there has been extensive use of transpedicular fixation to regain stability of the destabilized spine, destabilized through wide laminectomies, major facetectomies, disease processes such as degenerative or lytic spondylolisthesis, or as a sequel to severe infection. Revision surgery is known to be a difficult decision; it is usually associated with increased morbidity, neural complications like dural tears, perineural fibrosis, and secondary neural canal stenosis. To minimize such morbidities during revision surgery, instrumented posterolateral and posterior lumbar interbody fusion (PLIF) procedures have been developed. More recently transforaminal lumbar interbody fusion (TLIF) through choosing a more lateral door with a graft or a cage graft has been recommended to decrease morbidities observed with PLIF cages for treatment of patients with failed back surgery. Purpose The aim of this study was to evaluate the results of instrumented transforaminal interbody fusion in treatment of failed back surgery and to prove its efficacy and competence as a successful alternative procedure to PLIF surgery with less morbidity especially in revision cases. Methods Forty-two patients with previous failed back surgery, all suffering from low back pain and 12 suffering from sciatica, were treated by instrumented TLIF with and without cages. Average follow-up was 36 months. Patients were evaluated for time to union, relief from symptoms, neurologic recovery, complications, and return to normal activity. The Visual Analog Scale and the Oswestry Disability Index were used to measure clinical outcome. Results The results were excellent in 35 patients (83.3%), good in four patients (9.5%), and fair in three patients (7.1%). According to postoperative radiographs, fusion was complete in 6 months in 33 patients (78.6%), in 9 months in 39 patients, and in 12 months in 42 patients. Conclusion TLIF is a very effective procedure, yielding a high rate of union and functional recovery from failed back surgery due to different causes including previous spinal fusions, with a low rate of complications. | ||||
| Keywords | ||||
| failed spine surgery; posterior lumbar interbody fusion; Transforaminal lumbar interbody fusion | ||||
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