TREATMENT OF UPPER LUMBAR DISC HERNIATION BY MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHENGYong ,  WANGJian , YUANChao , ZHENGWenjie , LIChangqing , ZHANGZhengfeng , ZHOUYue

Department of Orthopaedics, Affiliated Xinqiao Hospital, the Third Military Medical University, Chongqing, 400037, P. R. China;

Corresponding author：

WANGJian, Email: tonywjxq@aliyun.com

Keywords：

Upper lumbar disc herniation; Minimally invasive surgery; Transforaminal lumbar interbody fusion

DOI：

10.7507/1002-1892.20140108

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Objective To investigate the effectiveness and safety of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for upper lumbar disc herniation. Methods Retrospective analysis was made on the clinical data of 26 patients with upper lumbar disc herniation, who were in line with the selection criteria and underwent MIS-TLIF in 14 patients (MIS-TLIF group) and open transforaminal lumbar interbody fusion (OTLIF) in 12 patients (OTLIF group) between December 2007 and May 2012. There was no significant difference in gender, age, disease duration, level of disc herniation, side of disc herniation between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, and complications were compared between 2 groups. The clinical outcome was assessed using the visual analogue scale (VAS) and the Oswestry disability index (ODI) scores. The fusion rate was determined by using CT three-dimensional reconstruction and dynamic lumbar radiography at last follow-up. Results Primary healing of incisions was obtained in both groups. No difference was found in operation time between 2 groups (t=0.858, P=0.399), but MIS-TLIF group had less intraoperative blood loss and postoperative drainage volume than OTLIF group (P<0.05). The average follow-up duration was 34.1 months with a range of 12-50 months. No complication of dural tear, infection, spinal nerve trauma, and implant failure occurred. The VAS scores of lower back pain and radicular pain and ODI scores at preoperation showed no significant difference between 2 groups (P>0.05). The VAS score of lower back pain and ODI score at 1 day after operation in MIS-TLIF group were significantly lower than those in the OTLIF group (P<0.05), but no difference was found in VAS scores of radicular pain between 2 groups (P>0.05). Difference in all scores was not significant at last follow-up between 2 groups (P>0.05). The fusion rate was 92.8% (13/14) in MIS-TLIF group, and was 100% (12/12) in OTLIF group at last follow-up. Conclusion MIS-TLIF is a safe and effective procedure for upper lumbar disc herniation as an alternative to other techniques.

Citation： ZHENGYong, WANGJian, YUANChao, ZHENGWenjie, LIChangqing, ZHANGZhengfeng, ZHOUYue. TREATMENT OF UPPER LUMBAR DISC HERNIATION BY MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(4): 480-484. doi: 10.7507/1002-1892.20140108 Copy

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2.	Kortelainen P, Puranen J, Koivisto E, et al. Symptoms and signs of sciatica and their relation to the localization of the lumbar disc herniation. Spine (Phila Pa 1976), 1985, 10(1):88-92.
3.	Tokuhashi Y, Matsuzaki H, Uematsu Y, et al. Symptoms of thoracolumbar junction disc herniation. Spine (Phila Pa 1976), 2001, 26(22):E512-518.
4.	Sanderson SP, Houten J, Errico T, et al. The unique characteristics of "upper" lumbar disc herniations. Neurosurgery, 2004, 55(2):385-389.
5.	Isaacs RE, Podichetty VK, Santiago P, et al. Minimally invasive microendoscopy-assisted transforamin-al lumbar interbody fusion with instrumentation. J Neurosurg Spine, 2005, 3(2):98-105.
6.	Schwender JD, Holly LT, Rouben DP, et al. Minimally invasive trmasforaminal lumbar interbody fusion (TLIF):technical feasibility and initial results. J Spinal Disord Tech, 2005, 18 Suppl 1:S1-6.
7.	Seheufler KM, Dohmen H, Vougioukas VI. Percutaneous transforaminal lumbar interbody fusion for the treatment of degenerative lumbar instability. Neurosurgery, 2007, 60(4 Suppl 2):203-213.
8.	Suk SI, Lee CK, Kim WJ, et al. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine (Phila Pa 1976), 1997, 22(2):210-220.
9.	Shah RR, Mohammed S, Saifuddin A, et al. Comparison of plain radiographs with CT scan to evaluate interbody fusion following the use of titanium interbody cages and transpedicular instrumentation. Eur Spine J, 2003, 12(4):378-385.
10.	Cutler AR, Siddiqui S, Mohan AL, et al. Comparison of polyetheretherketone cages with emoral cortical bone allograft as a single-piece interbody spacer in transforaminal lumbar interbody fusion. J Neurosurg Spine, 2007, 5(6):534-539.
11.	Houten JK, Post NH, Dryer JW, et al. Clinical and radiographically/neuroimaging documented outcome in transforaminal lumbar interbody fusion. Neurosurg Focus, 2006, 20(3):E8.
12.	Kawaguchi Y, Matsui H, Tsuji H, et al. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine (Phila Pa 1976), 1996, 21(8):941-944.
13.	王建, 张正丰, 李长青, 等. 微创经椎间孔腰椎椎间融合术翻修治疗腰椎退变性疾病. 脊柱外科杂志, 2012, 10(1):13-16.
14.	胡志军, 范顺武, 赵兴. 微创后路腰椎椎体间融合术椎旁软组织解剖与评估. 国际骨科学杂志, 2007, 28(5):295-297.
15.	Ozgur BM, Yoo K, Rodriguez G, et al. Minimal-invasive techniques for transforaminal lumbar interbody fusion. Eur Spine J, 2005, 14(9):887-894.
16.	Saberi H, Isfahani AV. Higher preoperative Oswestry Disability Index is associated with better surgical outcome in upper lumbar disc herniations. Eur Spine J, 2008, 17(1):117-121.
17.	Ahn Y, Lee SH, Lee JH, et al. Transforaminal percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation:clinical outcome, prognostic factors, and technical consideration. Acta Neurochir (Wien), 2009, 151(3):199-206.
18.	Choi JW, Lee JK, Moon KS, et al. Transdural approach for calcified central disc herniations of the upper lumbar spine. Technical note. J Neurosurg Spine, 2007, 7(3):370-374.
19.	Kim DS, Lee JK, Jang JW, et al. Clinical Features and Treatments of Upper Lumbar Disc Herniations. J Korean Neurosurg Soc, 2010, 48(2):119-124.
20.	杨进, 孔清泉, 宋跃明, 等. 微创小切口与开放经椎间孔腰椎椎间融合术治疗单节段腰椎退变疾患的近期疗效比较. 中国修复重建外科杂志, 2013, 27(3):262-267.
21.	王建, 周跃, 张正丰, 等. 微创经椎间孔腰椎体间融合术治疗腰椎滑脱症的临床研究. 中华外科杂志, 2011, 49(12):1076-1080.
22.	Shunwu F, Xing Z, Fengdong Z, et al. Minimally invasive transforaminal lumar interbody fusion for the treatment of degenerative lumbar disease. Spine (Phila Pa 1976), 2010, 35(17):1615-1620.
23.	梁博伟, 殷国前, 赵劲民, 等. 微创经椎间孔椎间融合术治疗退变性腰椎失稳. 中国修复重建外科杂志, 2011, 25(12):1449-1454.

1. Albert TJ, Balderston RA, Heller JG, et al. Upper lumbar disc herniations. J Spinal Disord, 1993, 6(4):351-359.
2. Kortelainen P, Puranen J, Koivisto E, et al. Symptoms and signs of sciatica and their relation to the localization of the lumbar disc herniation. Spine (Phila Pa 1976), 1985, 10(1):88-92.
3. Tokuhashi Y, Matsuzaki H, Uematsu Y, et al. Symptoms of thoracolumbar junction disc herniation. Spine (Phila Pa 1976), 2001, 26(22):E512-518.
4. Sanderson SP, Houten J, Errico T, et al. The unique characteristics of "upper" lumbar disc herniations. Neurosurgery, 2004, 55(2):385-389.
5. Isaacs RE, Podichetty VK, Santiago P, et al. Minimally invasive microendoscopy-assisted transforamin-al lumbar interbody fusion with instrumentation. J Neurosurg Spine, 2005, 3(2):98-105.
6. Schwender JD, Holly LT, Rouben DP, et al. Minimally invasive trmasforaminal lumbar interbody fusion (TLIF):technical feasibility and initial results. J Spinal Disord Tech, 2005, 18 Suppl 1:S1-6.
7. Seheufler KM, Dohmen H, Vougioukas VI. Percutaneous transforaminal lumbar interbody fusion for the treatment of degenerative lumbar instability. Neurosurgery, 2007, 60(4 Suppl 2):203-213.
8. Suk SI, Lee CK, Kim WJ, et al. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine (Phila Pa 1976), 1997, 22(2):210-220.
9. Shah RR, Mohammed S, Saifuddin A, et al. Comparison of plain radiographs with CT scan to evaluate interbody fusion following the use of titanium interbody cages and transpedicular instrumentation. Eur Spine J, 2003, 12(4):378-385.
10. Cutler AR, Siddiqui S, Mohan AL, et al. Comparison of polyetheretherketone cages with emoral cortical bone allograft as a single-piece interbody spacer in transforaminal lumbar interbody fusion. J Neurosurg Spine, 2007, 5(6):534-539.
11. Houten JK, Post NH, Dryer JW, et al. Clinical and radiographically/neuroimaging documented outcome in transforaminal lumbar interbody fusion. Neurosurg Focus, 2006, 20(3):E8.
12. Kawaguchi Y, Matsui H, Tsuji H, et al. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine (Phila Pa 1976), 1996, 21(8):941-944.
13. 王建, 张正丰, 李长青, 等. 微创经椎间孔腰椎椎间融合术翻修治疗腰椎退变性疾病. 脊柱外科杂志, 2012, 10(1):13-16.
14. 胡志军, 范顺武, 赵兴. 微创后路腰椎椎体间融合术椎旁软组织解剖与评估. 国际骨科学杂志, 2007, 28(5):295-297.
15. Ozgur BM, Yoo K, Rodriguez G, et al. Minimal-invasive techniques for transforaminal lumbar interbody fusion. Eur Spine J, 2005, 14(9):887-894.
16. Saberi H, Isfahani AV. Higher preoperative Oswestry Disability Index is associated with better surgical outcome in upper lumbar disc herniations. Eur Spine J, 2008, 17(1):117-121.
17. Ahn Y, Lee SH, Lee JH, et al. Transforaminal percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation:clinical outcome, prognostic factors, and technical consideration. Acta Neurochir (Wien), 2009, 151(3):199-206.
18. Choi JW, Lee JK, Moon KS, et al. Transdural approach for calcified central disc herniations of the upper lumbar spine. Technical note. J Neurosurg Spine, 2007, 7(3):370-374.
19. Kim DS, Lee JK, Jang JW, et al. Clinical Features and Treatments of Upper Lumbar Disc Herniations. J Korean Neurosurg Soc, 2010, 48(2):119-124.
20. 杨进, 孔清泉, 宋跃明, 等. 微创小切口与开放经椎间孔腰椎椎间融合术治疗单节段腰椎退变疾患的近期疗效比较. 中国修复重建外科杂志, 2013, 27(3):262-267.
21. 王建, 周跃, 张正丰, 等. 微创经椎间孔腰椎体间融合术治疗腰椎滑脱症的临床研究. 中华外科杂志, 2011, 49(12):1076-1080.
22. Shunwu F, Xing Z, Fengdong Z, et al. Minimally invasive transforaminal lumar interbody fusion for the treatment of degenerative lumbar disease. Spine (Phila Pa 1976), 2010, 35(17):1615-1620.
23. 梁博伟, 殷国前, 赵劲民, 等. 微创经椎间孔椎间融合术治疗退变性腰椎失稳. 中国修复重建外科杂志, 2011, 25(12):1449-1454.

Chinese Journal of Reparative and Reconstructive Surgery

TREATMENT OF UPPER LUMBAR DISC HERNIATION BY MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION

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