Ws. Rosenberg et Pv. Mummaneni, Transforaminal lumbar interbody fusion: Technique, complications, and early results, NEUROSURGER, 48(3), 2001, pp. 569-574
OBJECTIVE: To demonstrate the safety, surgical efficacy, and advantages of
the transforaminal approach for lumbar interbody fusion when combined with
pedicle screw fixation,
METHODS: We retrospectively reviewed the records of 22 patients (age range,
34-63 yr; mean, 49 yr) with Grade I or II spondylolisthesis who underwent
transforaminal lumbar interbody fusion. Nineteen patients presented with lo
w back pain and associated radiculopathy, and three presented with low back
pain only. Transforaminal lumbar interbody fusion was performed at L4-L5 i
n 8 patients, L5-S1 in 11 patients, L3-L4 and L4-L5 in 2 patients, and L4-L
5 and L5-S1 in 1 patient. Periodic follow-up took place 1 to 12 months afte
r surgery (mean, 5.3 mo). Decompression is performed according to clinical
circumstances. Pedicle screws are placed, and a discectomy is carried out.
The cartilaginous endplates are removed. The interspace is gradually distra
cted, resulting in lost disc height being regained, and interbody fusion ca
ges are positioned. The pedicle screw-and-rod construct is then compressed,
restoring lumbar lordosis.
RESULTS: Low back pain completely resolved in 16 patients, moderate relief
from pain was achieved in 5 patients, and the pain was unchanged in one pat
ient. Nonneurological complications included intraoperative durotomy in one
patient and postoperative wound infection in two. In one patient, postoper
ative mild L5 motor paresis resolved. One patient had a temporary brachial
plexopathy due to intraoperative positioning, and one patient had periphera
l polyneuropathy secondary to prolonged intraoperative blood pressure cuff
inflation.
CONCLUSION: Transforaminal lumbar interbody fusion is a safe and effective
method for achieving circumferential spinal fusion via a single-stage proce
dure. This procedure is particularly useful in restoring disc space height
and lumbar lordosis.