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Minimally invasive transforaminal lumbar interbody fusion: Results of 23 consecutive cases.

Jhala A, Singh D, Mistry M - Indian J Orthop (2014)

Bottom Line: The advantages of minimally invasive spinal instrumentation techniques are less soft tissue injury, reduced blood loss, less postoperative pain and shorter hospital stay while achieving clinical outcomes comparable with equivalent open procedure.Fourteen patients had excellent results, a good result in 5 subjects, 2 subjects had fair results and 2 had poor results.The study demonstrates a good clinicoradiological outcome of minimally invasive TLIF.

View Article: PubMed Central - PubMed

Affiliation: Chirayu Orthopedic and Spine Hospital, Ahmedabad, Gujarat, India.

ABSTRACT

Background: The use of minimally invasive surgical (MIS) techniques represents the most recent modification of methods used to achieve lumbar interbody fusion. The advantages of minimally invasive spinal instrumentation techniques are less soft tissue injury, reduced blood loss, less postoperative pain and shorter hospital stay while achieving clinical outcomes comparable with equivalent open procedure. The aim was to study the clinicoradiological outcome of minimally invasive transforaminal lumbar interbody fusion.

Materials and methods: This prospective study was conducted on 23 patients, 17 females and 6 males, who underwent MIS-transforaminal lumbar interbody fusion (TLIF) followed up for a mean 15 months. The subjects were evaluated for clinical and radiological outcome who were manifested by back pain alone (n = 4) or back pain with leg pain (n = 19) associated with a primary diagnosis of degenerative spondylolisthesis, massive disc herniation, lumbar stenosis, recurrent disc herniation or degenerative disc disease. Paraspinal approach was used in all patients. The clinical outcome was assessed using the revised Oswestry disability index and Macnab criteria.

Results: The mean age of subjects was 55.45 years. L4-L5 level was operated in 14 subjects, L5-S1 in 7 subjects; L3-L4 and double level was fixed in 1 patient each. L4-L5 degenerative listhesis was the most common indication (n = 12). Average operative time was 3 h. Fourteen patients had excellent results, a good result in 5 subjects, 2 subjects had fair results and 2 had poor results. Three patients had persistent back pain, 4 patients had residual numbness or radiculopathy. All patients had a radiological union except for 1 patient.

Conclusion: The study demonstrates a good clinicoradiological outcome of minimally invasive TLIF. It is also superior in terms of postoperative back pain, blood loss, hospital stay, recovery time as well as medication use.

No MeSH data available.


Related in: MedlinePlus

Clinical photograph showing (a) polyetheretherketone cage (b) cage loaded with bone graft on an inserter
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Figure 3: Clinical photograph showing (a) polyetheretherketone cage (b) cage loaded with bone graft on an inserter

Mentions: Under general anesthesia the patients were positioned in the prone position on a radiolucent table on Iliac and chest rolls. Using AP and lateral fluoroscopic images, the pedicles and the midline structures were marked [Figure 1]. Skin incision of approximately 3 cm in length was made up to the fascia. With the help of the dilator tubes, using with the muscles splitting approach, the tubular retractor was docked over the facet joint [Figure 2]. The correct placement of the tubular retractor was checked fluoroscopically. The surgery was performed from the more symptomatic side, the inferior facet was resected and the exiting nerve and traversing root was identified and decompressed. A complete discectomy was done. The endplates were prepared using scrapers and angled curettes. The locally harvested bone graft obtained by local laminectomy was packed into the interbody space anteriorly. The correct size cage was packed with bone graft and inserted under fluoroscopic control [Figure 3].


Minimally invasive transforaminal lumbar interbody fusion: Results of 23 consecutive cases.

Jhala A, Singh D, Mistry M - Indian J Orthop (2014)

Clinical photograph showing (a) polyetheretherketone cage (b) cage loaded with bone graft on an inserter
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232824&req=5

Figure 3: Clinical photograph showing (a) polyetheretherketone cage (b) cage loaded with bone graft on an inserter
Mentions: Under general anesthesia the patients were positioned in the prone position on a radiolucent table on Iliac and chest rolls. Using AP and lateral fluoroscopic images, the pedicles and the midline structures were marked [Figure 1]. Skin incision of approximately 3 cm in length was made up to the fascia. With the help of the dilator tubes, using with the muscles splitting approach, the tubular retractor was docked over the facet joint [Figure 2]. The correct placement of the tubular retractor was checked fluoroscopically. The surgery was performed from the more symptomatic side, the inferior facet was resected and the exiting nerve and traversing root was identified and decompressed. A complete discectomy was done. The endplates were prepared using scrapers and angled curettes. The locally harvested bone graft obtained by local laminectomy was packed into the interbody space anteriorly. The correct size cage was packed with bone graft and inserted under fluoroscopic control [Figure 3].

Bottom Line: The advantages of minimally invasive spinal instrumentation techniques are less soft tissue injury, reduced blood loss, less postoperative pain and shorter hospital stay while achieving clinical outcomes comparable with equivalent open procedure.Fourteen patients had excellent results, a good result in 5 subjects, 2 subjects had fair results and 2 had poor results.The study demonstrates a good clinicoradiological outcome of minimally invasive TLIF.

View Article: PubMed Central - PubMed

Affiliation: Chirayu Orthopedic and Spine Hospital, Ahmedabad, Gujarat, India.

ABSTRACT

Background: The use of minimally invasive surgical (MIS) techniques represents the most recent modification of methods used to achieve lumbar interbody fusion. The advantages of minimally invasive spinal instrumentation techniques are less soft tissue injury, reduced blood loss, less postoperative pain and shorter hospital stay while achieving clinical outcomes comparable with equivalent open procedure. The aim was to study the clinicoradiological outcome of minimally invasive transforaminal lumbar interbody fusion.

Materials and methods: This prospective study was conducted on 23 patients, 17 females and 6 males, who underwent MIS-transforaminal lumbar interbody fusion (TLIF) followed up for a mean 15 months. The subjects were evaluated for clinical and radiological outcome who were manifested by back pain alone (n = 4) or back pain with leg pain (n = 19) associated with a primary diagnosis of degenerative spondylolisthesis, massive disc herniation, lumbar stenosis, recurrent disc herniation or degenerative disc disease. Paraspinal approach was used in all patients. The clinical outcome was assessed using the revised Oswestry disability index and Macnab criteria.

Results: The mean age of subjects was 55.45 years. L4-L5 level was operated in 14 subjects, L5-S1 in 7 subjects; L3-L4 and double level was fixed in 1 patient each. L4-L5 degenerative listhesis was the most common indication (n = 12). Average operative time was 3 h. Fourteen patients had excellent results, a good result in 5 subjects, 2 subjects had fair results and 2 had poor results. Three patients had persistent back pain, 4 patients had residual numbness or radiculopathy. All patients had a radiological union except for 1 patient.

Conclusion: The study demonstrates a good clinicoradiological outcome of minimally invasive TLIF. It is also superior in terms of postoperative back pain, blood loss, hospital stay, recovery time as well as medication use.

No MeSH data available.


Related in: MedlinePlus