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Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
Minimally Invasive Transforaminal Interbody Fusion Versus Microdiscectomy Without Fusion for Recurrent Lumbar Disk
Salvatore D'Oria1, David Giraldi, Domenico Murrone
1From the Neurosurgical Unit, Miulli Hospital, Acquaviva delle Fonti, Italy (D'Oria, Giraldi, Murrone, Salamone, Tomatis, and Fanelli), and the Department of Neurosurgery, (Dr. Colamaria, Dr. Carbone) "Riuniti" Hospital, Foggia, Italy (Colamaria and Carbone), and the Department of Neurosurgery, University of Catania (Rossitto).
Objective:
The objective of this study was to compare the clinical outcome of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) versus standard revision diskectomy for recurrent lumbar disk herniation (RLDH).
Background:
RLDH is the most common cause of redo surgery after a microdiscectomy. Commonly, in patients without evidence of spinal instability, many surgeons would simply redo microdiscectomy, while others proceed to a redo microdiscectomy with arthrodesis. According to the literature, there is no evidence of what the best management of an RLDH would be.
Methods:
This study involved 90 patients who underwent lumbar microdiscectomy in the past and were now experiencing a new lumbar disk herniation for the first time. The patients were divided into two groups, each with 45 patients: group A received standard revision microdiscectomy, whereas group B received revision microdiscectomy with MIS TLIF.The Japanese Orthopaedic Association score, operating time, blood loss, duration of hospital stay, costs, and complications were all prospectively recorded in a database and examined. Back and leg discomfort were measured using the visual analog scale.
Results:
The mean total postoperative Japanese Orthopaedic Association score across the groups exhibited no statistically significant difference, nor did the preoperative clinical and epidemiological data. Although postoperative leg pain was comparable in both groups, postoperative lower back pain in group A was much worse than that in group B. Additional revision surgery was necessary for six individuals in group A. Group A had higher rates of dural rupture and postoperative neurological impairment. Group A experienced much less intraoperative blood loss, longer operation times, and postoperative hospital stays.
Conclusion:
In patients with RLDH, revision microdiscectomy is effective. In comparison with conventional microdiscectomy, MIS TLIF reduces intraoperative risk of dural rupture or neural injury, postoperative incidence of mechanical instability or recurrence, and postoperative lower back pain.
Study Design:
Prospective, randomized, multicenter, comparative study.
Insights
Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is more effective than standard revision diskectomy for recurrent lumbar disk herniation. MIS TLIF reduces complications and lower back pain, offering a better outcome for patients needing redo surgery.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Surgery
Background:
- Recurrent lumbar disk herniation (RLDH) is a common complication following initial microdiscectomy, often necessitating revision surgery.
- Current management strategies for RLDH lack definitive evidence, with options including repeat microdiscectomy or fusion.
- This study addresses the need for comparative data on surgical interventions for RLDH.
Purpose of the Study:
- To compare the clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) versus standard revision diskectomy for RLDH.
- To evaluate the efficacy and safety of MIS TLIF as a revision procedure for recurrent lumbar disc herniation.
Main Methods:
- A prospective, randomized, multicenter, comparative study involving 90 patients with RLDH.
- Patients were divided into two groups: standard revision microdiscectomy (n=45) and revision microdiscectomy with MIS TLIF (n=45).
- Outcomes assessed included Japanese Orthopaedic Association scores, operating time, blood loss, hospital stay, costs, complications, and pain using visual analog scale.
Main Results:
- No significant difference in postoperative Japanese Orthopaedic Association scores between groups.
- Postoperative lower back pain was significantly lower in the MIS TLIF group compared to the standard revision group.
- The MIS TLIF group demonstrated lower rates of dural rupture, postoperative neurological impairment, and need for additional revision surgery.
Conclusions:
- Revision microdiscectomy is an effective treatment for RLDH.
- MIS TLIF offers advantages over conventional microdiscectomy for RLDH, including reduced intraoperative risks and improved postoperative outcomes regarding pain and stability.
- MIS TLIF is recommended for managing RLDH to minimize complications and enhance patient recovery.
