Transforaminal lumbar interbody fusion: surgical technique and results in 24 patients

Sean A Salehi, Rabih Tawk, Aruna Ganju, Frank LaMarca, John C Liu, Stephen L Ondra
Neurosurgery 2004, 54 (2): 368-74; discussion 374

OBJECTIVE: The advantage of anterior column support and fusion in addition to pedicle fixation in patients with degenerative spinal disorders has become increasingly clear. With the increase in popularity of this treatment, a variety of techniques have been used to achieve the goal of anterior column support, fusion, and segmental instrumentation. Posterior lumbar interbody fusion has been used since the late 1940s in the treatment of degenerative lumbar spine. We evaluated a modification to posterior lumbar interbody fusion called transforaminal lumbar interbody fusion (TLIF).

METHODS: A retrospective analysis was performed on 24 patients (9 women, 15 men) who underwent TLIF. The approach involved a unilateral laminectomy and inferior facetectomy at the level of fusion. The interbody fusion was achieved from this unilateral approach by performing discectomy, arthrodesis, and insertion of one or two titanium cages packed with autologous bone. The average age of the patients in this study was 42.6 +/- 12.5 years. Five patients were smokers. Five cases were related to workmen's compensation. Seventeen patients' original symptoms were a combination of low back pain and radiculopathy. Ten patients had had a previous spine operation.

RESULTS: Eleven patients had L4-S1 TLIFs. The rest of the patients had a single-level TLIF (L2-S1). Average intensive care unit and floor days were 1.1 +/- 1.0 and 5.8 +/- 2.2 days, respectively. The number of days to ambulation was 2.8 +/- 1.6 days. There were a total of six self-limited complications in 24 patients (including one transient neurological complication). The average follow-up time was 16.9 +/- 9.1 months. Twenty-two patients had solid fusions. A modified Prolo scale (4 worst, 20 best) was used to evaluate the clinical outcome. The average score was 16.1 +/- 4.1.

CONCLUSION: TLIF is a reliable and safe technique for interbody support that can be performed with excellent clinical outcome. In the authors' experience, TLIF offers excellent exposure with minimal risk. This applies particularly in cases of repeat spine surgery, in which the presence of scar tissue makes traditional posterior lumbar interbody fusion techniques difficult or impossible. In addition, TLIF seems to be a viable alternative to anteroposterior circumferential fusion and/or anterior lumbar interbody fusion.

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