#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

TLIF Technique for Treatment of Foraminal Lumbar Disc Herniation in Isthmic Spondylolisthesis


Authors: J. Šrámek 1,2;  R. Bertagnoli 1
Authors‘ workplace: Klinika ProSpine, Bogen, Německo 1;  Fakulta biomedicínského inženýrství, České vysoké učení technické v Praze 2
Published in: Cesk Slov Neurol N 2015; 78/111(4): 468-473
Category: Short Communication

Overview

Aim:
The purpose of the study was to examine a group of patients with unilateral radicular pain caused by foraminal lumbar disc herniation in isthmic spondylolisthesis and treated surgically using pedicle screw stabilisation and TLIF technique with a banana-shaped interbody cage, and to compare this approach with other surgical techniques.

Material and methods:
In 2011 and 2012, a total of 32 patients underwent surgical treatment of the L4–L5 and L5–S1 isthmic spondylolisthesis. In a group of nine patients, acute unilateral radicular pain was the main clinical manifestation. Foraminal lumbar disc herniation was found on the MRI in all patients in the group. Herniation was removed, the foramen decompressed and a banana-shaped cage in combination with pedicle screw fixation was implanted using a posterior approach.

Results:
Radicular pain rapidly improved after the surgery in all patients. On the VAS, leg pain improved from the mean of 7.3 before the surgery to 0.4 24 month after the surgery, back pain from 4.3 to 2.2 and the mean for ODI improved from 48 to 15. Neither wound healing problem nor neurological deterioration was found. X-ray revealed solid interbody fusion in all patients.

Conclusion:
The ALIF technique combined with pedicle screw fixation requires two surgeries, one with ventral, one with dorsal surgical approach. The PLIF technique is associated with epidural scarring and an increased risk of dural injury. The TLIF technique eliminates the risk of epidural scarring, its effectiveness in achieving solid bony interbody fusion is comparable with other interbody fusion techniques and it enables straightforward elimination of foraminal herniation.

Key words:
isthmic spondylolisthesis – foraminal herniation – transforaminal lumbar interbody fusion

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


Sources

1. Marchetti P, Bartolozzi P. Classification of spondylolisthesis as a guideline for treatment. In: Bridwell K, Dewald R, Hammerberg K (eds). Textbook of Spinal Surgery. 2nd ed. Philadelphia: Lippincott‑ Raven 1997: 1211– 1254.

2. Meyerding H. Spondylolisthesis. Surgical treatment and results. Surg Gynecol Obstet 1932; 54: 371– 377.

3. Barrey C, Jund J, Noseda O, Roussouly P. Sagittal balance of the pelvis‑ spine complex and lumbar degenerative disease: a comparative study of about 85 cases. Eur Spine J 2007; 16(9): 1459– 1467.

4. Mysliwiec L, Cholewicki J, Winkelpleck M, Eis G. MSU classification for herniated lumbar discs on MRI: toward developing objective criteria for surgical selection. Eur Spine J 2010; 19(7): 1087– 1093. doi: 10.1007/ s00586‑ 009‑ 1274‑ 4.

5. Lejeune J, Hladky J, Cotten A, Vinchon M, Christiaens J.Foraminal lumbar disc herniation. Experience with 83 patients. Spine 1994; 19(17): 1905– 1908.

6. MacMahon P, Taylor D, Duke D, Brennan D, Eustace S. Disc displacement patterns in lumbar anterior spondylolisthesis: contribution to foramina stenosis. Eur J Radiol 2009; 70(1): 149– 154. doi: 10.1016/ j.ejrad.2007.12.003.

7. Kim K, Chin D, Park J. Herniated nucleus pulposus in isthmic spondylolisthesis: higher incidence of foraminal and extraforaminal types. Acta Neurochir (Wien) 2009; 151(11): 1445– 1450. doi: 10.1007/ s00701‑ 009‑ 0411‑ 5.

8. Gill G, Manning J, White H. Surgical treatment of spondylolisthesis without spine fusion; excision of the loose lamina with decompression of the nerve roots. J Bone Jt Surg 1955; 37A(3): 493– 520.

9. Arts M, Pondaag W, Peul W, Thomeer R. Nerve root decompression without fusion in spondylolytic spondylolisthesis: long‑term results of Gill‘s procedure. Eur Spine J 2006; 15(10): 1455– 1463.

10. Grifka J, Möller J. Characteristics of an intervertebral disk herniation in spondylolisthesis. Z Orthop Grenzgeb 1991; 129(4): 362– 364.

11. Osterman K, Lindholm T, Laurent L. Late results of removal of the loose posterior element (Gill‘s operation) in the treatment of lytic lumbar spondylolisthesis. Clin Orthop Relat Res 1976; 117: 121– 128.

12. Poussa M, Tallroth K. Disc herniation in lumbar spondylolisthesis. Acta Orthop Scand 1993; 64(1): 13– 16.

13. Dehoux E, Fourati E, Madi K, Reddy B, Segal P. Posterolateral versus interbody fusion in isthmic spondylolisthesis: functional results in 52 cases with minimum follow‑up of 6 years. Acta Orthop Belg 2004; 70(6): 578– 582.

14. Krbec M. Přehled chirurgických technik –  úvod. In: Suchomel P, Krbec M (eds). Spondylolistéza. Dia­gnostika a terapie. Praha: Galén 2007: 69– 79.

15. Ye Y, Xu H, Chen D. Comparison between posterior lumbar interbody fusion and posterolateral fusion with transpedicular screw fixation for isthmic spondylolithesis: a meta‑analysis. Arch Orthop Trauma Surg 2013; 133(12): 1649– 1655. doi: 10.1007/ s00402‑ 013‑ 1868‑ 5.

16. Yehya A. TLIF versus PLIF in management of low grade spondylolisthesis. Bull Alex Fac Med 2010; 46(2): 127– 133.

17. el‑ Masry M, Khayal H, Salah H. Unilateral transforaminal lumbar interbody fusion (TLIF) using a single cage for treatment of low grade lytic spondylolisthesis. Acta Orthop Belg 2008; 74(5): 667– 671.

18. Vaněk P, Saur K. Transforaminální lumbo‑ sakrální mezitělová fúze (TLIF) s instrumentací: prospektivní studie s minimálně 20měsíčním sledováním. Cesk Slov Neurol N 2007; 70/ 103(5): 552– 557.

19. Kwon B, Berta S, Daffner S, Vaccaro A, Hilibrand A, Grauer J et al. Radiographic analysis of transforaminal lumbar interbody fusion for the treatment of adult isthmic spondylolisthesis. J Spinal Disord Tech 2003; 16(5): 469– 476.

20. Oh H, Lee S, Hong S. Anterior dislodgement of a fusion cage after transforaminal lumbar interbody fusion for the treatment of isthmic spondylolisthesis. J Korean Neurosurg Soc 2013; 54(2): 128– 131. doi: 10.3340/ jkns.2013.54.2.128.

21. Tormenti M, Maserati M, Bonfield C, Gerszten P, Moossy J, Kanter A et al. Perioperative surgical complications of transforaminal lumbar interbody fusion: a single‑center experience. J Neurosurg Spine 2012; 16(1): 44– 50. doi: 10.3171/ 2011.9.SPINE11373.

22. Mobasser J. Minimally invasive TLIF for the treatment of radiculopathy. [online]. Available from URL: http:/ / www.spineuniverse.com/ professional/ case‑ studies/ mobasser/ minimally‑ invasive‑ tlif‑ treatment‑ radiculopathy?nocache=1.

23. Parker S, Mendenhall S, Shau D, Zuckerman S, Godil S,Cheng J et al. Minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis: comparative effectiveness and cost‑utility analysis. World Neurosurg 2014; 82(1– 2): 230– 238. doi: 10.1016/ j.wneu.2013.01.041.

24. Seng C, Siddiqui M, Wong K, Zhang K, Yeo W, Tan Set al. Five‑year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion: a matched‑ pair comparison study. Spine 2013; 38(23): 2049– 2055. doi: 10.1097/ BRS.0b013e3182a8212d.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 4

2015 Issue 4

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#