Minimally Invasive Transforaminal Lumbar Interbody Fusion

Heung Tae Chung; Chae Oh Na; Sang Hoon Ha; Dong Ryul Shin

doi:10.7469/JKSS.2009.16.1.24

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Chung, Na, Ha, and Shin: Minimally Invasive Transforaminal Lumbar Interbody Fusion

Original Research

Journal of Korean Spine Surg 2009;16(1):24-29.

Published online: 18 January 2009

DOI: https://doi.org/10.7469/JKSS.2009.16.1.24

Minimally Invasive Transforaminal Lumbar Interbody Fusion

Heung Tae Chung, M.D., Chae Oh Na, M.D., Sang Hoon Ha, M.D., Dong Ryul Shin, M.D.

Department of Orthopaedic Surgery, Boomin Hospital

Address reprint requests to Chae Oh Na, M.D. Department of Orthopaedic Surgery, Boomin Hospital, 380-4 Deokcheon 1-dong, Buk-gu, Busan 616-819, Korea Tel: 82-51-330-3000, Fax: 82-51-337-5041, E-mail: osdcb@yahoo.co.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study design

A retrospective study

Objectives

To introduce the technique of minimally invasive transforaminal lumbar interbody fusion and examine its clinical and radiologic results.

Summary of Literature Review

Transforaminal lumbar interbody fusion with a mini-incision using a tubular retractor was recently developed. The aim of this procedure is to reduce the approach-related morbidity and achieve better results in an effective and safe manner.

Materials and Methods

Thirty eight patients were followed up for more than 1 year. Their mean age was 57 years and the mean follow-up was 19 months. The diagnosis was spinal stenosis, spondylolisthesis and recurred herniated nucleus pulposus in 22, 14 and 2 patients, respectively. The Oswestry disability index, intervertebral disc space height, fusion rate and complications were evaluated.

Results

The Oswestry disability index improved from 30 points (range, 50~16 points) to 10 points (range, 2-24 points) at the last follow-up. Thirty-four patients (90%) showed excellent or good results. The intervertebral disc space height increased from 8.7 mm to 10.8 mm. Two cases showed nonunion but the clinical results were good. Complications included one case of infectious spondylitis requiring antibiotics, one case of cage dislodgement requiring additional surgery and one case of a pedicle screw malposition showing no clinical symptoms.

Conclusions

Minimally invasive transforaminal lumbar interbody fusion reduced the soft tissue injury and blood loss and shortened the recovery period compared to the traditional open techniques.

Keywords: Minimally invasive, Transforaminal lumbar interbody fusion (TLIF), Clinical result, Complication

REFERENCES

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Fig. 1.

A 26-mm-diameter tubular retractor in position.

Fig. 2.

View through the tubular retractor. The lateral margin of the transversing root is visible.

Fig. 3.

Using the Sextant system, percutaneous screw-rod fixaiotn is done.

Fig. 4.

Oswestry Disability Index Score, Preop : preoperative, Impo : immediate postoperative, Last F/U : last follow-up

Table 1.

Patients’ data

Variables
Age (years)	57(34-76)
M:F	12:26
Follow-up (months)	19(12-33)
Diagnosis
Recurred disc protrusion	2
Spinal stenosis	22
Spondylolytic spondylolisthesis	8
Degenerative spondylolisthesis	6
Level of fusion
One level	27
Two level	11

Table 2.

4 Categories used in assessing patients following operation (Kirkaldy-Willis score)

Categories	Assessment	NO
Excellent	The patient has returned to his normal work and other activities with little or no complaint.	30
Good	The patient has returned to his normal work but may have some restriction in other activities and may on occasion after heavy work have recurrent back pain requiring a few day's rest.	4
Fair	The patient has to reduce his working capacity, taking a lighter job or working part-time, and may occasionally have recurrence of pain requiring abscent from work for one to two weeks, once or twice a year.	3
Poor	The patient does not return to work.	1
Total		38

NO=Number

Table 3.

Bridwell's anterior fusion grades

		Cases
Grade I	Fusion with remodeling and trabeculae	2
Grade II	Graft intact, not fully remodeled and incorporated though. No lucencies.	34
Grade III	Graft intact, but a definite lucency at the top or bottom of the graft.	2
Grade IV	Definitely not fused with resorption of bone graft and with collapse.

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