Transforaminal lumbar interbody fusion: Technique, complications, and early results

Citation
Ws. Rosenberg et Pv. Mummaneni, Transforaminal lumbar interbody fusion: Technique, complications, and early results, NEUROSURGER, 48(3), 2001, pp. 569-574
Citations number
13
Categorie Soggetti
Neurology,"Neurosciences & Behavoir
Journal title
NEUROSURGERY
ISSN journal
0148396X → ACNP
Volume
48
Issue
3
Year of publication
2001
Pages
569 - 574
Database
ISI
SICI code
0148-396X(200103)48:3<569:TLIFTC>2.0.ZU;2-9
Abstract
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.