Unilateral transforaminal lumbar interbody fusion and bilateral anterior-column fixation with two Brantigan I/F cages per level: clinical outcomes during a minimum 2-year follow-up period

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>There are no published reports of unilateral transforaminal lumbar interbody fusion (TLIF) in which two Brantigan I/F cages were placed per level through a single portal to achieve bilateral anterior-column support. The authors describe such a surgical technique and evaluate the clinical outcomes of this procedure.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Data obtained in 86 (93.5%) of the first 92 consecutive patients who underwent the procedure were retrospectively reviewed; the minimum follow-up duration was 2 years. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scoring system. Disc height, disc angle, cage positioning in the axial plane, and fusion status were radiographically evaluated.</jats:p> <jats:p>The mean follow-up period was 33.8 months. The mean improvement in the JOA score was 77.2%. Fusion was successful in 93% of the cases. According to the Farfan method, the mean anterior and posterior disc heights increased from 20.2 and 16.9% preoperatively to 35.9 and 22.7% at follow up, respectively (p &lt; 0.01). The mean disc angle increased from 4.8° preoperatively to 7.5° at last follow-up examination (p &lt; 0.01). Two cages were correctly placed to achieve bilateral anterior-column support in greater than 85% of the cases. The following complications occurred: hardware migration in two patients and deep infection cured by intravenous antibiotic therapy in one patient.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Unilateral TLIF involving the placement of two Brantigan cages per level led to good clinical results. Two Brantigan cages were adequately placed via a single portal, and reliable bilateral anterior-column support was achieved. Although the less invasive unilateral approach was used, the outcomes were as good as those in many reported series of posterior lumbar interbody fusion in which the Brantigan cages were placed via the bilateral approach.</jats:p></jats:sec>

Biomechanical study of the lumbar spine using a unilateral pedicle screw fixation system

“…7 Recently, this unilateral PS system has been more frequently employed in combination with transforaminal lumbar interbody fusion (TLIF) rather than in posterolateral fusion and posterior lumbar interbody fusion (PLIF). 8,9 As described above, favorable results have been reported for lumbar fusion in combination with a unilateral PS system. However, little data are available on the biomechanical properties of the system.…”

Comparison of SpineJet™ XL and Conventional Instrumentation for Disk Space Preparation in Unilateral Transforaminal Lumbar Interbody Fusion

“…In spite of this claim, some reports indicate that in actual practice, only 80-90% of the posterior disk space is removed during total diskectomy 11) . Conventional TLIF has been shown to reduce complications; clinical studies with follow-ups between 12 and 64 months have found that fusion rates for TLIF are similar to those expected for other interbody fusion techniques-that is, more than 90% 5,8,12,14,20) . However, the major criticism of unilateral TLIF procedures is that unilateral diskectomy reduces the probability of fusion because of the limitations imposed by using conventional tools and because it is more difficult to remove sufficient disk material during diskectomy and endplate preparation than during PLIF, especially from the contralateral posterior side using a unilateral approach.…”

Comparison of minimally invasive versus open transforaminal lumbar interbody fusion in two-level degenerative lumbar disease

“…All the details are illustrated in Table 2. Discussion TLIF, first described by Harms and Rolinger [16], is currently used increasingly as an alternative procedure for lumbar posterolateral fusion or posterior lumbar interbody fusion (PLIF) [14,[17][18][19]. As with the PLIF procedure, TLIF offers a number of potential benefits, including increased fusion surface area, complete access for medial and lateral decompression and restoration of intervertebral body height [20].…”