Outcomes of surgical treatment in form of transforaminal lumbar interbody fusion in patients of degenerative lumbar spine

Abstract

Introduction:The goal of fusion of the lumbar spine is to alleviate pain. Different circumferential fusion techniques have been described such as combined anterior-posterior fusion (APF), instrumented posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF). The TLIF procedure has rapidly gained popularity because of its posterolateral transforaminal discectomy and fusion. It has been reported as a safe technique, without the potential complications described when using combined APF and PLIF techniques. Materials and methods:A retrospective clinical and radiographic study of 52 patients with symptomatic degenerative lumbar spine treated with TLIF was performed. Through a classic posterior midline incision, the side of facetectomy was chosen according to the subject's symptoms of leg pain if present. A posterolateral discectomy, endplate preparation and insertion of a peek cage with additional bone graft locally harvested were performed. The posterior fusion was instrumented with pedicle screws and titanium rods. Results: Improvement in ODI score from 63% to 13% and in mJOA score from 9 to 25 at final follow up shows TLIF procedure improves the general condition of patient. Few complications (Dural tear, Local wound infection, Broken implant) encountered during study (observed in 25% patients) do not affect overall long term outcome. PLIF has been associated with high incidences of neurological complications, up to 13.6% permanent neurologic lesions in Barnes' et al. study, which is not observed in TLIF. Conclusion: TLIF allows surgeon to achieve anterior fusion with low risk of injuring the nerve root by minimal retraction of the root. The advantages of this technique are: less complications, the simplicity and speed of execution and versatility. Adjacent segment disease and accelerated disc degeneration above or below the level of fusion is major concern on long term follow up.