Minimally invasive transforaminal lumbar interbody fusion:characteristics of screw malposition and cage displacement / 中国组织工程研究

ABSTRACT

BACKGROUND:Traditional open surgical transforaminal lumbar interbody fusion often needs a broader dissection of the paraspinal soft tissue and longer stretch time of soft tissue, induces greater surgical trauma and more blood loss. Minimal y invasive transforaminal lumbar interbody fusion (MIS-TLIF) may reduce or avoid these shortcomings. However, MIS-TLIF technique needs a process of learning curve. Correctly understanding the MIS-TLIF technique and dealing with their associated complications, have an important clinical significance. OBJECTIVE:To summarize the MIS-TLIF complications for treatment of lumbar disease, and explore the prevention and treatment strategies. METHODS:Between May 2008 and May 2012, 100 patients with lumbar disease were treated using MIS-TLIF. Al of patients had typical low back pain combined with leg pain, and were ineffective by conservative treatment for 6 months. There were lumbar spinal stenosis syndrome in 42 cases, lumbar spondylolisthesis in 31 cases, and lumbar disc herniation with lateral recess stenosis in 27 cases. The operative levels included L 3/4 in 2 patients, L 4/5 in 28 patients, L 5/S 1 in 50 patients, L 3-L 5 in 2 patients, and L 4-S 1 in 18 patients. The intraoperative and postoperative complications were recorded. RESULTS AND CONCLUSION:One patient appeared extradural hemorrhage 1 000 mL and was given blood transfusion, no complications were found. Pedicle screw malposition was found in 11 pedicle screws (11/435, 2.5%). Only one patient had new L 5 radicular pain due to impingement by the tip of a bicortical S 1 screw upon the lumbosacral trunk anterior to the sacrum. This screw was re-positioned at a subsequent procedure, with resolution of the radicular pain. Interbody cage malposition was found in 2 patients with 2 cages (2/120, 1.7%) after operations, they showed no clinical symptoms and were not treated. One patient with one cage (1/120, 0.8%) appeared cage displacement during fol ow-up, which required twice revision surgeries, one is cage re-position and the other is posterior interbody fusion. Within one month after operations, two patients had poor visualization in the right pulmonary arteriography, which was diagnosed as pulmonary embolism and was treated with thrombectomy and thrombolysis. No death and other consequence were found. Experimental findings indicate hat, MIS-TLIF is a safe, reliable and effective surgery for treating lumbar diseases, with few complications.