Transforaminal lumbar interbody fusion (TLIF) and unilateral transpedicular fixation

TLIF (transforaminal lumbar interbody fusion) is a method of interbody fusion, which is alternative to other vertebral fusion wherein, with an approach through intervertebral foramen, through lateral segment of intervertebral space, complications occurring with other methods are reduced. Today, there are numerous versions of this method in terms of implants and transplants. At our Department patients with axial pain resistant to conservative treatment of minimum six months underwent TLIF method with unilateral transpendicular fixation with polyaxial screws, CAGE filled with autologous transplant obtained by lamina resection, and posteromedial contralateral fusion. 22 procedures were performed at 22 levels, 10 for relapsing hernia, and 12 for disc herniation combined with degenerative changes on the same level. Pain reduction was significant; according to VAS score, lumbar pain was reduced from preoperative 8.5 +/- 0.8 to 2.4 +/- 0.85 (-72.63%) a year after, and leg pain was reduced significantly from preoperative 8.45 +/- 0.91 to 2.072 +/- 0.81 (71%) 12 months after surgery. The Wilcoxon paired test demonstrated a significant difference between preoperative VAS score and the value measured 12 months after surgery (n = 22, Z = 4.1, p < 0.001) leg and back, respectively. In 15 (68.2%) patients fusion was evidenced on standard X-ray of lumbar spine, and in 4 patients, with aggravated clinical presentation, fusion in 2 patients and pseudoarthrosis in 2 patients were evidenced by CT. Total 17 patients (77.3%) showed signs of fusion. In our study we demonstrated that unilateral ipsilateral transpedicular fixation, with positioning of one CAGE filled with local autologous transplant represents a reliable and successful method of treatment of axial lumbar pain.