Abstract and Introduction
Abstract
Object: Posterior lumbar interbody fusion (PLIF) has been shown to be effective in the treatment of axial low-back pain. Minimally invasive spine surgery for arthrodesis has several advantages, including quicker patient recovery, less postoperative pain, and less destruction of adjacent tissue. The purpose of this paper is to evaluate the clinical outcomes after PLIF procedures in which unilateral pedicle screw fixation was used.
Methods: Prospective data were collected in 34 patients undergoing a one-level minimally invasive transforaminal lumbar interbody fusion (TLIF) in 2003. Conservative therapy, including physical therapy and aggressive multimodality pain management, had failed in all patients. Selection was based on magnetic resonance imaging studies demonstrating degenerative disc disease. All patients underwent a unilateral TLIF procedure in conjunction with posterior unilateral pedicle screw fixation. Twenty patients in whom the follow-up duration was longer than 6 months were included in this study.
The follow-up duration in all patients ranged from 6 to 12 months. Seventeen (85%) of 20 patients had a good result, which was defined as a greater than 20-point reduction in the Oswestry Disability Index (ODI) score. The other three patients had no improvement. The mean preoperative ODI score of 57 improved to 25 after surgery (p < 0.005). In the 17 patients who demonstrated improvement, the mean ODI score improved from 57 to 18. The patients' visual analog scale pain scores improved from 8.3 to 1.4 (p < 0.005) after surgery. In patients who received Workers' Compensation, three (75%) of four improved. Follow-up computerized tomography scans were obtained in all 20 patients at 6 months. At that time, 13 of the patients demonstrated some degree of fusion, and no symptomatic pseudarthrosis was noted.
Conclusions: Minimally invasive TLIF in conjunction with unilateral pedicle screw instrumentation is an effective treatment for axial low-back pain in appropriately selected patients.
Introduction
Cloward initially described lumbar interbody fusion without posterior instrumentation in 1953. Although his procedure was performed by others, it failed to be widely adopted and results were equivocal. The combination of lumbar interbody fusion and posterior lumbar instrumentation improved surgical outcomes for axial lumbar pain. Since these initial reports, the TLIF operation, which requires a one-sided approach to the intravertebral space, has become widely accepted. Several minimally invasive approaches for the TLIF procedure have been reported.
In this paper, we describe a modification of the minimally invasive TLIF technique in which unilateral pedicle screw instrumentation is used. The minimally invasive approach makes unilateral instrumentation particularly appealing. The purpose of this study is to evaluate clinical outcomes in patients undergoing a minimally invasive TLIF with unilateral instrumentation.