Surgical treatment of recurrent lumbar disc herniation by transforaminal lumbar interbody fusion

Abstract

Between 2001 and 2005, 43 patients (average age 54.2, range 36-68 years) with recurrent lumbar disc herniation underwent reoperation with the transforaminal lumbar interbody fusion (TLIF) technique at our unit. All cases were followed up for 24-72 months (mean 45 months) and graded using the Japanese Orthopaedic Association (JOA) score system pre-and post-operation and during the follow-up period. The leg pain of all patients was relieved significantly within one month postoperatively. The mean JOA score was improved from 9.3 before surgery to 25.0 at the final follow-up visit (P<0.0001). The average recovery rate was 86.0% (range 52-100%). General clinical outcome was excellent in 23 (53.5%) patients, good in 14 (32.6%) and fair in 6 (13.9%). The fusion rate was 100% two years postoperatively. Three patients (7%) had transient neurological deficits, which resolved completely within 3 months. There were no major complications. We, therefore, believe the TLIF technique to be an effective procedure with satisfactory clinical results for the treatment of recurrent lumbar disc herniation.Résumé Entre 2001 et 2005, 43 patients (âge moyen 54,2 ans entre 36 à 68 ans) ont bénéficié d'une réintervention chirurgicale avec arthrodèse inter corporéale par technique transforaminale pour récidive de hernie discale lombaire. Tous ces patients ont été suivis en moyenne pendant 45 mois et évalués selon le score de la JOA en pré et post opératoire. Les douleurs des membres de tous ces patients ont été nettement améliorées dans le premier mois post opératoire. Le score de la JOA a été également améliorée de 9,3 avant l'intervention à 25 lors de la dernière revue de ces malades (P<0,0001). Le taux moyen de récupération a été de 86% (52 à 100%). L'évolution clinique générale a été excellente chez 23 patients (53,5%), bonne chez 14 patients (32,6%) et médiocre chez 6 patients (13,9%). Le taux de fusion a été de 100% en post opératoire. 3 patients (7%) ont eu des troubles neurologiques transitoires qui ont complète-ment régressé dans les trois mois. Il n'y a pas eu de complications majeures. L'étude technique TLIF est une technique efficace qui nous donne satisfaction dans le traitement des récidives de hernies discales lombaires.

Unilateral percutaneous pedicle screw instrumentation with minimally invasive tlif for the treatment of recurrent lumbar disk disease. 2 years follow-up

“…Recurrent lumbar disk herniation is a major surgical failure with a reported incidence of 5 to 11% (3,13). The optimal technique for the treatment is controversial.…”

“…The optimal technique for the treatment is controversial. Some surgeons believe that repeat diskectomy is the treatment of choice with clinical results similar to the primary surgery while others believe that fusion is necessary for treating disk reherniation (3,7). Since repeated diskectomy requires the removal of more disc material and/or facet joint, it can increase the risk of segmental instability (3).…”

“…Economic benefits may be realized with lower cost of decreased surgical implant numbers, shorter hospitalization and earlier return to work. Although there are many potential benefits of the Mis-TLIF procedure, the Lumbar fusion could be obtained by both posterolateral and/ or interbody fusion techniques (3,19). However, conventional lumbar fusion is associated with significant muscle stripping and retraction that can adversely affect both short-and longterm patient outcomes (6).…”

“…Treatment of recurrent lumbar disk herniation includes medical management and surgical intervention (20). Surgical techniques include rediskectomy with or without fusion (3,7).…”

Functional Outcome of Patients with Lumbar Intervertebral Disc Herniation after Minimally Invasive Microdiscectomy

“…The rate of improvement (RI) was graded into 4 groups : Excellent as ≥ 90 %; Good as 75 -89 %; Fair as 50 -74 % and Poor as < 49 % improvement. 6 Collected data was entered in Microsoft excel sheets and later imported in the Statistical Package for Social Sciences software for appropriate analysis.Significance over the period was calculated for JOA score by repeated measures ANOVA. For all statistical tests, pvalue < 0.05 was considered significant and p < 0.001 was highly significant.…”