Combined transforaminal lumbar interbody fusion with posterolateral instrumented fusion for degenerative disc disease can be a safe and effective treatment for lower back pain

Abstract

Background:Lumbar fusion is a proven treatment for chronic lower back pain (LBP) in the setting of symptomatic spondylolisthesis and degenerative scoliosis; however, fusion is controversial when the primary diagnosis is degenerative disc disease (DDD). Our objective was to evaluate the safety and effectiveness of lumbar fusion in the treatment of LBP due to DDD.Materials and Methods:Two-hundred and five consecutive patients with single or multi-level DDD underwent lumbar decompression and instrumented fusion for the treatment of chronic LBP between the years of 2008 and 2011. The primary outcome measures in this study were back and leg pain visual analogue scale (VAS), patient reported % resolution of preoperative back pain and leg pain, reoperation rate, perioperative complications, blood loss and hospital length of stay (LOS).Results:The average resolution of preoperative back pain per patient was 84% (n = 205) while the average resolution of preoperative leg pain was 90% (n = 190) while a mean follow-up period of 528 days (1.5 years). Average VAS for combined back and leg pain significantly improved from a preoperative value of 9.0 to a postoperative value of 1.1 (P ≤ 0.0001), a change of 7.9 points for the cohort. The average number of lumbar disc levels fused per patient was 2.3 (range 1-4). Median postoperative LOS in the hospital was 1.2 days. Average blood loss was 108 ml perfused level. Complications occurred in 5% of patients (n = 11) and the rate of reoperation for symptomatic adjacent segment disease was 2% (n = 4). Complications included reoperation at index level for symptomatic pseudoarthrosis with hardware failure (n = 3); surgical site infection (n = 7); repair of cerebrospinal fluid leak (n = 1), and one patient death at home 3 days after discharge.Conclusion:Lumbar fusion for symptomatic DDD can be a safe and effective treatment for medically refractory LBP with or without leg pain.

Instrumented Posterolateral Spinal Arthrodesis as an Effective Treatment for Single Level Symptomatic Vacuum Lumbar Disc Degeneration in Elderly Patients

“…Although some surgeon have advocated minimally invasive interbody fusion techniques to overcome these drawbacks, 3 there are concerns that even if utilized, these minimally invasive techniques might escalade the risk of nerve roots injury 9 with seemingly no -at least-obvious added benefits in other studies. 13 In this study, the most commonly affected spinal levels were L4/5 followed by L5/S1, similar to incidence reported by Deukmedjian et al, 6 and D'Anastasi et al, 5 but opposite to Ki-Chan et al, 2 where incidence of L5/S1 affection level was higher. The Mean duration of the instrumented PLF surgeries was 137±29 minutes, shorter than reported in other instrumented PLF series, as reported by An et al, 3 in their series of 46 patients where mean operative time was 163±42, and significantly shorter than time reported for single level open TLIF or PLIF surgeries in other studies 7,28 with mean operative time 237 and 198 minutes respectively.…”

First report of perforation of ligamentum flavum by sequestrated lumbar intervertebral disc

“…Our case should not be surprised because the intervertebral disc is the larger of two types of weight-bearing joints that make up the repeating vertebral motion segments in the spine. [ 18 ] Having broad knowledge of anatomy is essential for practicing neurosurgery. Certain anatomical structures call for detailed study due to their functional importance.…”

Inequality in leg length is important for the understanding of the pathophysiology of lumbar disc herniation

“…[ 3 4 5 ] It affects millions of people globally. [ 6 ] LBP is a common disorder with a lifetime prevalence of 85%. [ 7 8 ] In addition, it is one of the most common surgical practices performed by a spine surgeon.…”