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Abstract
Objectives
To evaluate the clinical and radiological results of a transforaminal lumbar interbody fusion for the treatment of non-union after a posterolateral spinal fusion.
Literature Review Summary
In the case of nonunion after a posterolateral spinal fusion, the anterior column should be reconstructed. However, due to epidural scarring and fibrosis, the approach to the anterior column by conventional posterior lumbar interbody fusion (PLIF) is difficult. The authors have modified the original transforaminal lumbar interbody fusion (TLIF) developed by Dr. Harms, which offers potential advantages and provides a surgical alternative to the traditional methods.
Materials and Methods
Between January 2002 and A ugust 2003, 10 cases of TLIF for the treatment of non-unions after a posterolateral spinal fusion were performed. There were 8 male and 2 female cases. The mean age of the patient was 63.3 years, ranging from 53 to 75 years. The levels of the TLIF were the L4- 5 and L5- S1 in 9 and 1 cases, respectively. The mean interval between the revision and previous operations was 21.3 months, ranging 12 to 48 months. In the preoperative radiography, bony defect in posterolateral fusion mass, halos around screws and abnormal motions in the stress view were observed.
Using the previous midline approach, exposure of the bilateral articular and transverse processes were performed. With a small osteotome, the superior articular process was removed along a line parallel to the superior margins of the pedicular screw head, to allow access to the neural foramen and lateral aspect of the disc space. The TLIF was performed through this space by inserting cages. The loosened screw was replaced by one that was thicker, coupled with a cancellous bone graft in the foramen.
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Fig. 1.
(A) (B) Roentgenograms of 75-year-old man who underwent revision spine surgery from L2 to L5 12 months before index spine operation. The AP and lateral views show pseudarthrosis with retrolisthesis between L4 and L5 and rod dislodgement from L5 right pedicular screw. Left L5 screw was not inserted.
Fig. 2.
(A) (B) Postoperative one year roentgenograms showing solid arthrodesis after reconstruction of L4-5 by transforaminal lumbar interbody fusion. The anterior column was reconstructed with 2 PEEK (poly-ether-ether-ketone) cages. The right L5 screw was replaced with thicker one and the left L5 screw was newly inserted.
Table 1.
Patient dermographics performed TLIF for the treatment of nonunions after posterolateral spinal fusion
Table 2.
4 Categories used in assessing patients following operation (Kirkaldy-Willis score)
Table 3.
Results of TLIF for the treatment of nonunions after lumbar posterolateral spinal fusion
| NO | Operative time (min) | Blood loss (cc) | TLIF approach | Extension of fusion level | K-W∗ score | Complication |
|---|---|---|---|---|---|---|
| 1 | 240 | 0300 | bilateral | (+) | Good | |
| 2 | 240 | 0350 | bilateral | (+) | Excellent | |
| 3 | 130 | 0320 | bilateral | (-) | Good | |
| 4 | 250 | 0450 | unilateral | (-) | Good | |
| 5 | 210 | 0350 | bilateral | (-) | Good | |
| 6 | 170 | 0450 | bilateral | (+) | Good | Nonunion |
| 7 | 200 | 1150 | bilateral | (-) | Fair | |
| 8 | 280 | 0900 | bilateral | (+) | Good | |
| 9 | 200 | 1800 | bilateral | (-) | Poor | |
| 10 | 320 | 1200 | bilateral | (-) | Good | |
| Avg | 224 | 0727 |
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