Minimal Invasive Unilateral Transforaminal Lumbar Interbody Fusion by Sublaminar Decompression - Comparison to Bilateral Approach -

Sang-Hyuk Min; Sung-Su Hwang

doi:10.4055/jkoa.2009.44.1.76

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Min and Hwang: Minimal Invasive Unilateral Transforaminal Lumbar Interbody Fusion by Sublaminar Decompression - Comparison to Bilateral Approach -

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(1): 76-82.

Published online: 23 February 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.1.76

Minimal Invasive Unilateral Transforaminal Lumbar Interbody Fusion by Sublaminar Decompression - Comparison to Bilateral Approach -

Sang-Hyuk Min, M.D., Sung-Su Hwang, M.D.

Department of Orthopeadic Surgery, Dankook University College of Medicine, Cheonan, Korea.

Address reprint requests to Sang-Hyuk Min, M.D. Department of Orthopaedic Surgery, Dankook University Medical Center, 16-5, Anseo-dong, Cheonan 330-715, Korea. Tel: +82.41-550-3950, Fax: +82.41-556-3238, osmin71@naver.com

Abstract

Purpose

This is a comparison of the unilateral and bilateral approaches for minimal invasive transforaminal lumbar interbody fusion (TLIF), and we did so by measuring the clinical and radiological results.

Materials and Methods

This study examined a consecutive series of 47 patients who underwent one-level TLIF (26 cases of the unilateral approach and 21 cases of the bilateral approach to the lumbar spine) and the follow-up data was compared with a minimum 1-year follow-up. Sublaminar decompression and contralateral foraminectomy were done in all the case of using the unilateral approach. The age of each patient, the amount of intraoperative blood loss, the postoperative drainage, the transfusion requirement and the surgery time were investigated. The clinical outcomes were analyzed using the visual analogue scale, the SF-36 Physical Composite Score (PCS) and the Oswestry disability index (ODI). The preoperative, postoperative & last follow-up changes in the height and angles of the disc in the fused segments and the lumbar lordotic angles were radiologically analyzed.

Results

There was no statistical difference between the two groups in terms of the clinical and radiographic results at the last follow-up. But the unilateral approach-group was found to have a less blood loss, less postoperative drainage, a lesser requirement for transfusion and a shorter surgery time.

Conclusion

This study confirms that the unilateral approach can be the better way if the technical problems are solved.

Keywords: Unilateral approach, Sublaminar decompression, Transforaminal lumbar interbody fusion

Figures and Tables

Fig. 1

The clinical photograph showing paramedian skin incision 2.5 cm from midline before surgery.

Fig. 2

Tilting patient against the operator makes it easy to approach during operation.

Fig. 3

Postoperative gross finding showing complete decompression spinal canal and foramen by sublaminar decompression & contralateral foraminectomy. A: The arrow indicates decompressed thecal sac by sublaminar decompression. B: The arrow indicates decompressed traversing root by contralateral foraminectomy.

Fig. 4

(A) Preoperative CT film of a 50-year-old female patient. (B) Postoperative CT fim showing complete decompression of spinal canal and foramen by sublaminar decompression & contralateral for aminectomy, comparing with preoperative one.

Table 1

Perioperative Data of the Two Groups

Table 2

VAS between Two Groups with the Last Follow up

Table 3

ODI (Oswestry Disability Index) between Two Groups with the Last Follow up

Table 4

SF-36 Physical Composite Score between Two Groups with the Last Follow up

Table 5

Radiographic Outcomes between the Two Groups with the Last Follow up

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