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.

Figures

Fig. 1a–c

A 40-year-old female with L4–5 recurrent disc herniation. She had undergone discectomy with laminotomy because of L4–5 disc herniation 11 years previously. a Preoperative sagittal magnetic resonance image (MRI) showing L4–5 disc reherniation. b Preoperative axial MRI showing L4–5 disc reherniation and left nerve root compression. c Preoperative lateral X-ray showing L4–5 disc space narrowed

Fig. 2

Postoperative plain lateral radiograph showing L4–5 instrumented with the transforaminal lumbar interbody fusion (TLIF) technique; the disc height was restored

Fig. 3

Two years post-operatively lateral X-ray showing L4–5 solid fusion; the disc height was maintained