A modified transforaminal lumbar interbody fusion technique to decrease the incidence of postoperative radiculopathy: A prospective analysis of 216 patients
Journal Title: International Journal of Orthopaedics Sciences - Year 2017, Vol 3, Issue 3
Abstract
Reported incidence of postoperative intractable radiculopathy following posterior lumbar interbody fusion (PLIF) and transforaminal lumbr interbody fusion (TLIF) is between 7-14% affecting postoperative recovery. Excessive medial dural retraction in PLIF and exiting nerve root injury in TLIF during cage insertion are the proposed itiologies for battered root syndrome. Aim of the study was to identify the incidence of postoperative radiculopathy on the side of cage insertion following a modified TLIF technique. 216 patients who underwent fusion by modified-TLIF approach were prospectively analyzed. The inferior facet of cranial vertebra alone was excised retaining the pars interarticularis of cranial vertebra and superior facet of caudal vertebra which from the posterior wall of intervertebral foramen. It provided adequate space for cage insertion without need for excessive dural retraction in addition to protecting the exiting nerve root. The severity of postoperative radiculopathy on the side of cage insertion was assessed by visual analog scale (VAS). Of the 216 patients, L4-5 level was fused in 137, L5-S1 in 72 and L3-4 in 7 patients. Severe postoperative radiculopathy (VAS: 10) was observed only in three patients with an incidence of 1.4% who needed prolonged hospitalization for its recovery. L3-L4 was the fused level in these three patients while none of them in L4-5 and L5-S1 levels had such severe radiculopathy. Lumbar interbody fusion by modified TLIF (Hemi-TLIF) approach involving excision of only the inferior facet decreases the incidence of post-operative radiculopathy. However, we recommed this procedure only at L4-5 and L5-S1 levels where the spinal canal is relatively larger when compared to higher lumbar levels.
Authors and Affiliations
Dr. Subbiah M, Dr. Yegumuthu K
Keywords
Related Articles
- EP ID EP499793
- DOI 10.22271/ortho.2017.v3.i3i.91
- Views 125
- Downloads 0
Evaluation of surgical management of metacarpal fractures – A prospective clinical study
Introduction: Metacarpal fractures constitutes between 14-28% of all visits to the hospital following trauma. Too often these metacarpal fractures are neglected or treated as minor injuries and results in major disabilit...
Transplantal distal migration of a tibial küntscher nail: About a case at Sylvanus Olympio hospital of Lome
Open leg fractures are a therapeutic challenge because of the complexity of the initial management, the poor choice of immediate immobilization, and the difficult treatment of infectious and bone complications. The use o...
Incidence and type of complications following traumatic extremity amputations: preliminary report from a teaching hospital
Amputation is one of the oldest surgical procedure and a good amputation results in optimal functional outcome by providing healthy residual limb. Advances in prosthetics has enabled amputee with diverse options and bett...
Functional outcome of surgical management of floating knee injuries in adults (Ipsilateral femoral and tibia fractures) and its prognostic indicators
Background: Ipsilateral femoral and tibial fractures are termed as floating knee injuries [1, 2]. They range from simple diaphyseal fractures to complex intraarticular fractures. Combinations of diaphyseal, metaphyseal a...
Results of open fractures of tibia treated by external fixator as primary and definitive procedure
Unilateral AO external fixator was used as primary and definitive procedure for treatment of open fractures of both bones of leg. There were 37 patients, and according to Gustilo and Anderson classification there were 20...