Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Surgical Management of Post-Discectomy Syndrome

Abstract

Study Design: This was a prospective case series of 30 patients with post-discectomy syndrome with an average of 18 months of follow-up (level IV).Purpose: The efficacy of post-discectomy syndrome managed by minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) was evaluated.Overview of Literature: In post-discectomy syndrome wherein conservative treatment had failed, the best surgical treatment modality still remains controversial.Methods: Patients were functionally assessed using the Visual Analog Scale (VAS) for low back pain (LBP) and leg pain (LP) and Oswestry Disability Index (ODI). Radiological fusion was confirmed with plain X-rays and when indicated with computed tomography scan at 12 months postoperatively. A total of 30 patients with 37 operated at lumbar levels with failed discectomy surgery who met our inclusion criteria were treated with MIS-TLIF.Results: The ODI of all patients showed significant improvement from a mean of 73.78% preoperatively to 16.67% at 1 month and 14.13% at 12 months postoperatively. The preoperative LBP VAS score (mean, 4.37) showed a significant decrease (<i>p</i> <0.001) to 1.90 at 1 month and 1.10 at 12 months. Preoperative LP VAS score of limb pain averaged 7.53 and showed a significant (<i>p</i> <0.001) decrease to 3.47 at 1 month and 1.10 at 12 months. All patients attained radiological fusion at 12 months.Conclusions: MIS-TILF constitutes a valid and effective treatment option for patients with post-discectomy syndrome.

Surgical Stabilization for Post-Operative Discitis Patients Concerning Pain Relief and Functional Outcomes

“…One should get an early MRI whenever there is the slightest suspicion of discitis. 19 Serial inammatory markers are important, although ESR takes longer to return to normal. Inammatory markers remain high even after clinical improvement in the early post-operative period.…”

Chronic pain after spine surgery: Insights into pathogenesis, new treatment, and preventive therapy

“…These studies were mainly randomized controlled clinical trials over the past 20 years, excluding those using the combined treatment and studies classified as Level V evidence. CPSS, chronic pain after spine surgery; LDH, lumbar disc herniation; CFT, cognitive functional therapy; MBRS, mindfulness-based stress reduction; NSAID, nonsteroidal anti-inflammatory drugs; SCS, spinal cord stimulation; HF-SCS, high-frequency 10 ​kHz SCS; DRGS, dorsal root ganglion stimulation; IDDS, intrathecal drug delivery system; MDT, microdiscectomy [ [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] ]. …”

“…In addition to the aforementioned individual treatments and re-operation [ [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] ], a promising new strategy for treating CPSS is the use of combination therapies. This approach may tailor the patient-specific treatment and reduce the limitations and potential side effects of individual treatments.…”

Lumbar Interbody Fusion and Osteobiologics for Lumbar Fusion

“…TLIF can also be safely performed in the upper lumbar segment. TLIF may be a good option in revision cases because a lateral approach avoids the postoperative scar tissue of a posterior approach [ 26 - 28 ]. Also, TLIF preserves the interlaminar surface and facet joint on the contralateral side, allowing them to be used as an additional surface area for fusion.…”