A modified procedure of single-level transforaminal lumbar interbody fusion reduces immediate post-operative symptoms: a prospective case-controlled study based on two hundred and four cases

Abstract

Study design This is a prospective case-controlled study.Purpose The purpose of this study is to investigate the effect of a modified transforaminal lumbar interbody fusion (TLIF) on the immediate post-operative symptoms in patients with lumbar disc herniation (LDH) accompanied with stenosis. Methods A total of 204 LDH patients with single-level TLIF were enrolled. According to the sequence of the placement of rods and cage, patients were divided into group R (rod-prior-to-cage) and group C (cage-prior-to-rod). Neurological function was evaluated by the Japanese Orthopedic Association (JOA) score. Radiological assessment includes height of intervertebral space (HIS), foraminal height (FH), foraminal area (FA), and segmental lordosis (SL). Change of original symptoms (pain/numb) and new-onset symptoms (pain/numb) after surgery were also recorded. Results Patients in group R had less change of HIS at L3/4, L4/5, and L5/S1 levels compared with pre-operation (all p > 0.05), whereas group C had larger change (all p < 0.05). No statistical difference was found in FH between the two groups before and after surgery at L3/4, L4/5, and L5/S1, respectively (all p > 0.05). In terms of FA, patients in group R had better improvement after surgery than those in group C at L3/4 and L4/5 (both p < 0.05). Patients in both groups acquired good improvement of neurological function. However, there were fewer patients in group R who experienced post-operative leg pain or numb compared with those in group C (p < 0.05). ConclusionThe modified open TLIF can significantly reduce the incidence of immediate post-operative symptoms for patients with single-level lumbar disc herniation via installation of rods prior to insertion of cage and the "neural standard" should serve as the goal of decompression for spine surgeons to restore disc/foraminal height and to minimize nerve distraction.

Clinical impact and imaging results after a modified procedure of ACDF: a prospective case-controlled study based on ninety cases with two-year follow-up

“…However, there have been no studies regarding the cage placement with or without releasing the Caspar cervical retractor after decompression is associated with postoperative axial neck pain. In the present study, in none-spread group, due to the release of Caspar cervical retractor after decompression, the height of intervertebral space was restored to its “natural height”, cervical physiological lordosis was restored, and the height and cross-sectional area of intervertebral foramen were moderately increased [ 23 ]. An increase in intervertebral foramen cross-sectional area indicates the increased outlet space of nerve root, which may improve blood supply and reduce compression of damaged nerves.…”

A Novel Capsule Lumbar Interbody Fusion (CLIF) in Treating Foot Drop due to Lumbar Degenerative Diseases: a Prospective, Observational Study

“…All patients accepted X-rays, MRI, and/or CT before operation. Considering the surgical levels of all patients with foot drop in this study involved L4/5, we chose the height of intervertebral space (HIS), foraminal height (FH), foraminal area (FA), and segmental lordosis (SL) at the level as the research parameters (Figure 2) [8].…”

“…e HIS was defined as the distance between the midpoints of cephalic and caudal endplate of the intervertebral space, which was used to evaluate the effect of spine shortening [16]. FH denoted the maximum distance between the lower margin of the superior pedicle and upper margin of the inferior pedicle [8]. FA was determined as illustrated in Figure 2.…”

“…ese two parameters were used to evaluate the potential compression of spine shortening on the nerve root at intervertebral foramina. SL was defined as the angle between the lines parallel to the inferior endplate and the superior endplate of the index disc, which was used to assess the lumbar alignment [8].…”

“…However, disputation still exists. Our previous study found that impairment caused by axial traction of the lumbar nerve root may be another major contributor to symptoms including pain, numbness, and weakness of low extremities in patients with LDD and recommended that the decompression of the lumbar spine should not only include the management of the surrounding compression (herniated disc or narrow intervertebral foramina) of the neural elements but also include the release of the axial tension of the nerve root [7,8]. However, whether the release of the lumbar nerve root is effective to the recovery of foot drop remains unknown.…”