Transforaminal lumbar interbody fusion as revision surgery for patients previously treated by discectomy or instrumentation of the lumbar spine

Abstract

Purpose:Transforaminal lumbar interbody fusion (TLIF) is a surgical method that allows stable fusion of the anterior spinal column and restoration of disc height and lumbar lordosis. The aim of this study was to evaluate the clinical and radiological data of the patients who underwent lumbar discectomy, posterior instrumentation and laminectomy or TLIF surgery and who applied to our clinic with the complaint of discogenic back or leg pain and investigate the effectiveness of procedure.Material and Methods:Between the years 2012-2016, patients who underwent TLIF procedure were analyzed retrospectively. Inclusion criteria; patients undergone surgery due to any disc pathology from the lumbar region, complaints that did not respond to a minimum of 6 weeks of conservative treatment, patients undergoing revision surgery with two levels or more TLIF procedure with posterior instrumentation and a follow-up period longer than 2 years. Radiological and clinical data of 13 patients who met these criteria were examined for the study.Results:The study group consisted of 11 women and 2 men. The mean follow-up period was 39.3 months (range 26-58). The mean age was 62.2 (range 56-71). 7 patients had previously undergone lumbar discectomy, 4 patients had posterior instrumentation and laminectomy, 2 patients had posterior instrumentation and TLIF procedure. The dominant complaint was back pain in all patients. There were also complaints of varying rates of radicular pain and combinations of neurological deficit. Indications for revision surgery; lumbar degenerative disc disease, recurrent lumbar disc herniation, lumbar spinal canal stenosis, segmental instability and spondylolisthesis with two levels and higher. A total of 77, mean 5.9 (±1.4) pedicle screws were placed. A total of 32, average 2.4 (±0.5) levels of TLIF were applied. In 8 (61.5%) patients, pedicle screws was augmented with cement. The mean operative time was 378.8 min, and the mean amount of blood loss was 684.6 ml. The mean amount of autotransfusion and allogeneic blood transfusion was 569.2 ml. Mean duration of hospital stay was 4.6 days. One patient had dural tear during the operation. In one patient, the wound drainage that started in the postoperative 10. day was healed with wound debridement and antibiotic treatment. None of the patients had proximal or distal adjacent segment fracture, implant failure, nonunion or loss of correction during the follow-up. Complete neurological recovery was observed in all patients except the patient who was admitted with a 6-month history of foot drop.Conclusions:TLIF is a safe and effective procedure for the treatment of spinal pathologies in revision surgery. Elimination of spinal stenosis and instability, decompression of nerve roots, restoration of intervertebral disc heights, restoring lumbar lordosis, neutralization of global spinal balance and pain relief are possible.