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A Clinical Investigation of Contralateral Neurological Symptom after Transforaminal Lumbar Interbody Fusion (TLIF).

Bai J, Zhang W, Zhang X, Sun Y, Ding W, Shen Y - Med. Sci. Monit. (2015)

Bottom Line: The differences in contralateral foramen area and disc-height index(DHI) before and after surgery were compared between Group S and a random sample of 40 cases of non-symptomatic group patients (group N).The time of symptom appearance, duration, and symptomatic severity (JOA VAS score) were compared between Group T and O.Compared with Group T, the symptoms of Group O patients appeared earlier, persisted longer, and were more serious (p<0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of The Third Hospital of Hebei Medical University, Key Biomechanical Laboratory of Orthopedics, Shijiazhuang, Hebei, China (mainland).

ABSTRACT

Background: The aim of this study was to analyze treatment outcomes and morbidity of contralateral neurological symptom in patients after TLIF surgery and to explore its possible causes.

Material and methods: A retrospective study was conducted involving a total of 476 patients who underwent TILF from 2009 to 2012 in our hospital. These cases were divided into a symptomatic group (Group S) and a non-symptomatic group. The differences in contralateral foramen area and disc-height index(DHI) before and after surgery were compared between Group S and a random sample of 40 cases of non-symptomatic group patients (group N). In addition, according to whether the patient underwent second surgery, Group S patients were further divided into a transient neurologic symptoms group (Group T) and an operations exploration group (Group O). The time of symptom appearance, duration, and symptomatic severity (JOA VAS score) were compared between Group T and O.

Results: Among the 476 patients, 18 had postoperative contralateral neurological symptoms; thus, the morbidity was 3.7815%. The indicators in Group S were lower than in Group N in the differences in contralateral foramen area and disc-height index(DHI) before and after surgery (p<0.05). Five patients (Group O) in Group S had second surgery because of invalid conservative treatment. The surgical exploration rate was 1.0504%. Compared with Group T, the symptoms of Group O patients appeared earlier, persisted longer, and were more serious (p<0.05).

Conclusions: Contralateral neurological symptom is a potential complication after TLIF, and its causes are diverse. Surgical explorations should be conducted early for those patients with the complication who present with obvious nerve damage.

No MeSH data available.


Related in: MedlinePlus

(A, B) MRI of Case 2 – preoperative lumbar intervertebral herniation between L4 and first sacral, most severe at lumbar vertebral disc 5 – sacral 1, sacral spinal stenosis. (C, D) Case 2 – direct and lateral X-ray image of lumbar vertebra after surgery. (E) Case 2 – postoperative CT scan showed that pedicle screw position was acceptable. (F) CT scan of Case 2 – postoperative intervertebral foramen showed a free graft at the right side of L5 – sacral 1 gap, causing nerve root compression of the right side.
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f2-medscimonit-21-1831: (A, B) MRI of Case 2 – preoperative lumbar intervertebral herniation between L4 and first sacral, most severe at lumbar vertebral disc 5 – sacral 1, sacral spinal stenosis. (C, D) Case 2 – direct and lateral X-ray image of lumbar vertebra after surgery. (E) Case 2 – postoperative CT scan showed that pedicle screw position was acceptable. (F) CT scan of Case 2 – postoperative intervertebral foramen showed a free graft at the right side of L5 – sacral 1 gap, causing nerve root compression of the right side.

Mentions: The results of this study show that group T and D were significantly different in terms of time of symptom appearance, duration, symptom severity, and response to dehydration (Tables 3, 4). This implies that mechanical compression at the contralateral nerve root should be considered for patients who have contralateral neurological symptom that is earlier, longer in duration, and more severe, and who have poorer response to dehydrating drugs, as well as typical signs of nerve root compression, such as the positive contralateral Lasègue’s test, decreased muscle strength, and skin sensory loss in the corresponding nerve root dominated region. Further CT imaging is therefore of higher diagnostic value. In Case 1 in group D, for example, a lateral X-ray showed that pedicle screw position was acceptable after the first surgery, but CT showed there was a bias in pedicle screw placement, thus compressing the nerve root (Figure 1). CT results of Case 2 showed a shift of the intervertebral bone graft, which caused nerve compression (Figure 2). In addition, there was an obvious reduction of the contralateral foramen area in Cases 3, 4, and 5 before and after surgery (Figure 3). This suggests that when signs and symptoms are consistent, CT scans of surgical segment pedicle, intervertebral foramen, and space should be carried out. The fixation location, intervertebral foramen morphology, and condition of decompressing bone implantation should also be examined. Furthermore, for those cases in which signs and symptoms are not typical and imaging examinations cannot determine the nature of the pain, diagnostic nerve root block can serve as a good diagnostic basis.


A Clinical Investigation of Contralateral Neurological Symptom after Transforaminal Lumbar Interbody Fusion (TLIF).

Bai J, Zhang W, Zhang X, Sun Y, Ding W, Shen Y - Med. Sci. Monit. (2015)

(A, B) MRI of Case 2 – preoperative lumbar intervertebral herniation between L4 and first sacral, most severe at lumbar vertebral disc 5 – sacral 1, sacral spinal stenosis. (C, D) Case 2 – direct and lateral X-ray image of lumbar vertebra after surgery. (E) Case 2 – postoperative CT scan showed that pedicle screw position was acceptable. (F) CT scan of Case 2 – postoperative intervertebral foramen showed a free graft at the right side of L5 – sacral 1 gap, causing nerve root compression of the right side.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4492481&req=5

f2-medscimonit-21-1831: (A, B) MRI of Case 2 – preoperative lumbar intervertebral herniation between L4 and first sacral, most severe at lumbar vertebral disc 5 – sacral 1, sacral spinal stenosis. (C, D) Case 2 – direct and lateral X-ray image of lumbar vertebra after surgery. (E) Case 2 – postoperative CT scan showed that pedicle screw position was acceptable. (F) CT scan of Case 2 – postoperative intervertebral foramen showed a free graft at the right side of L5 – sacral 1 gap, causing nerve root compression of the right side.
Mentions: The results of this study show that group T and D were significantly different in terms of time of symptom appearance, duration, symptom severity, and response to dehydration (Tables 3, 4). This implies that mechanical compression at the contralateral nerve root should be considered for patients who have contralateral neurological symptom that is earlier, longer in duration, and more severe, and who have poorer response to dehydrating drugs, as well as typical signs of nerve root compression, such as the positive contralateral Lasègue’s test, decreased muscle strength, and skin sensory loss in the corresponding nerve root dominated region. Further CT imaging is therefore of higher diagnostic value. In Case 1 in group D, for example, a lateral X-ray showed that pedicle screw position was acceptable after the first surgery, but CT showed there was a bias in pedicle screw placement, thus compressing the nerve root (Figure 1). CT results of Case 2 showed a shift of the intervertebral bone graft, which caused nerve compression (Figure 2). In addition, there was an obvious reduction of the contralateral foramen area in Cases 3, 4, and 5 before and after surgery (Figure 3). This suggests that when signs and symptoms are consistent, CT scans of surgical segment pedicle, intervertebral foramen, and space should be carried out. The fixation location, intervertebral foramen morphology, and condition of decompressing bone implantation should also be examined. Furthermore, for those cases in which signs and symptoms are not typical and imaging examinations cannot determine the nature of the pain, diagnostic nerve root block can serve as a good diagnostic basis.

Bottom Line: The differences in contralateral foramen area and disc-height index(DHI) before and after surgery were compared between Group S and a random sample of 40 cases of non-symptomatic group patients (group N).The time of symptom appearance, duration, and symptomatic severity (JOA VAS score) were compared between Group T and O.Compared with Group T, the symptoms of Group O patients appeared earlier, persisted longer, and were more serious (p<0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of The Third Hospital of Hebei Medical University, Key Biomechanical Laboratory of Orthopedics, Shijiazhuang, Hebei, China (mainland).

ABSTRACT

Background: The aim of this study was to analyze treatment outcomes and morbidity of contralateral neurological symptom in patients after TLIF surgery and to explore its possible causes.

Material and methods: A retrospective study was conducted involving a total of 476 patients who underwent TILF from 2009 to 2012 in our hospital. These cases were divided into a symptomatic group (Group S) and a non-symptomatic group. The differences in contralateral foramen area and disc-height index(DHI) before and after surgery were compared between Group S and a random sample of 40 cases of non-symptomatic group patients (group N). In addition, according to whether the patient underwent second surgery, Group S patients were further divided into a transient neurologic symptoms group (Group T) and an operations exploration group (Group O). The time of symptom appearance, duration, and symptomatic severity (JOA VAS score) were compared between Group T and O.

Results: Among the 476 patients, 18 had postoperative contralateral neurological symptoms; thus, the morbidity was 3.7815%. The indicators in Group S were lower than in Group N in the differences in contralateral foramen area and disc-height index(DHI) before and after surgery (p<0.05). Five patients (Group O) in Group S had second surgery because of invalid conservative treatment. The surgical exploration rate was 1.0504%. Compared with Group T, the symptoms of Group O patients appeared earlier, persisted longer, and were more serious (p<0.05).

Conclusions: Contralateral neurological symptom is a potential complication after TLIF, and its causes are diverse. Surgical explorations should be conducted early for those patients with the complication who present with obvious nerve damage.

No MeSH data available.


Related in: MedlinePlus