Efficacy of less invasive posterior lumbar interbody fusion as revision surgery for patients with recurrent symptoms after discectomy

Abstract

Recurrence of back or leg pain after discectomy is a well-recognised problem with an incidence of up to 28%. Once conservative measures have failed, several surgical options are available and have been tried with varying degrees of success. In this study, 42 patients with recurrent symptoms after discectomy underwent less invasive posterior lumbar interbody fusion (LI-PLIF). Clinical outcome was measured using the Oswestry Disability Index (ODI), Short Form 36 (SF-36) questionnaires and visual analogue scales for back (VAS-BP) and leg pain (VAS-LP). There was a statistically significant improvement in all outcome measures (p < 0.001). The debate around which procedure is the most effective for these patients remains controversial. Our results show that LI-PLIF is as effective as any other surgical procedure. However, given that it is less invasive, we feel that it should be considered as the preferred option.

Short-term and long-term revision rates after lumbar spine discectomy versus laminectomy: a population-based cohort study

“…Fusion of the symptomatic spinal segment during revision spinal surgery is related to successful outcomes. 44–47 In our study, no significant differences were observed in the final spinal fusion surgery rates after initial spinal surgery between patients who received lumbar discectomy (11.25%) and those who received lumbar laminectomy (12.08%).…”

Clinical study of bilateral decompression via vertebral lamina fenestration for lumbar interbody fusion in the treatment of lower lumbar instability

“…With the addition of a conventional resection of 1/3-1/2 inside the small joint for intra-operative decompression, the diameter of the general bone window is 14–18 mm and the area is 2.4–3.0 mm 2 . The full spinal undercutting decompression (21) requires careful surgery. The proper usage of TFC input protection devices is able to perfectly resolve the contradiction between the ‘limited approach’ and the exposed operative field to avoid nerve damage, iatrogenic instability and other adverse complications.…”

“…Part of the cortex in the basilar section of the spinous process may be removed to allow fenestration. Following fenestration, full undercutting decompression should be performed, with equal attention given to the central spinal canal and nerve root canal, particularly for the removal of pressure factors, including ossified posterior longitudinal ligament, hyperplastic osteophytes in the posterior vertebrae, medial margin of cohered and hyperplastic articular process, narrow parapsidal furrow of the superior articular process and a hyposulculus in the pedicle of the vertebral arch, lateral recess and lateral ligament flavum (21). While removing the osseous oppression, the soft pressure factors of the nucleus pulposus, the organized, calcified or hypertrophic fibers of the ligament fiavum and the posterior longitudinal ligament should not be ignored.…”

Failed back (surgery) syndrome: time for a paradigm shift

“…All articles, except those by Lakkol et al 20 and Brox et al, 12 retrospectively evaluated their data and are thus, by definition, subject to selection bias. The surgeon makes the decision regarding who receives a surgical intervention, and the surgeon also decides on the type of surgical intervention ( Table 2).…”