| Objective: To compare the clinical outcome and effects of transforaminal lumbar interbody fusion(TLIF) and posterior lumbar interbody fusion(PLIF) on recurrent lumbar disc protrusion(RLDP).Methods: From January 2007 to January 2011, 43 patients with RLDP were treated by TLIF (20 cases) or PLIF (23 cases); There were 28 males and 15 females. The age was from 27 to 67 years with an average of 42 years; all the patients were single-level protrusion, including 22 cases at the L4/5 level and 21 cases at the L5/S1 level. The primary procedure included laminectomy discectomy in 23 patients, unilateral hemilaminectomy discectomy in 13 patients, and bilateral laminectomy and total laminectomy discectomy in 7 patients. The recurrent time to the primary operation was 14-108 months (average 64 months). The location of recurrent disc protrusion was at the ipsilateral side in 28 cases and the contralateral side in 15 cases. X-ray, CT, MRI examination were undertook for all the cases. We record operation time, bleed amount during operation, length of clinotherapy, the number of complications, incidence of perioperative complication, length of interbody fusion, rate of interbody fusion; the visual analogue scale(VAS) score system and Oswestry disability index(ODI) score system were used to evaluate the clinical outcome, and the improvement rate was calculate; the height of disc space were measured by Roberts method at pro-operation and at the end of follow up; the Suk method were used to evaluate the interbody fusion rate.Result: The incision all healed by first intention. There were avulsions of spinal cord 4 cases: group TLIF 1 case and group PLIF 3 cases, which were repaired by using artificial spinal cord successfully. There were injured nerve 3 cases: group TLIF 1 case ,which was passing;And group PLIF 2 cases, which remised by closing the nerve root. There was no fracture of the fixation system. The incidence of perioperative complication in group PLIF (21.7%) was significantly higher than that of group TLIF (5.0%) (P<0.05). The operation time of TLIF was 109±17min, bleed amount during operation was 390±53.5ml, length of clinotherapy was 4.0±1.5day, length of interbody fusion was 3.3±0.79month, rate of interbody fusion was 100%. The operation time of PLIF was 143±21min, bleed amount during operation was 680±42.4ml, length of clinotherapy was 5.0±1.7day, length of interbody fusion was 3.6±0.56month, rate of interbody fusion was 100%. The operation time and bleed amount during operation of group PLIF were obviously higher than that of group TLIF (P < 0.05). There were no significant differences between two groups in terms of the length of clinotherapy, length of interbody fusion and rate of interbody fusion (P > 0.05). All of 43 patients were followed up for 12-36 months (average 20 months). At 1 week after operation, the satisfied rate of patients was 90.0% in group TLIF, 82.6%in group PLIF(P>0.05). There were no significant differences between two groups in terms of VAS and ODI when compared the preoperative value with the final follow-up value (P > 0.05). There was significant difference within group TLIF and PLIF in terms of VAS and ODI when compared the preoperative value with the final follow-up value (P < 0.05), but there were no significant differences among two groups in the improvement rate (P > 0.05). The intervertebral space grading method proposed by Roberts method was adopted to evaluate the intervertebral space height, the value in group TLIF was 2.10±0.91 at pre-operation, and 1.06±0.43 at the end of follow up (P<0.05); the value in group PLIF was 2.17±0.90 at pre-operation, and 1.05±0.58 at the end of follow up (P<0.05).Conclusion: Interbody fusion with either a PLIF or a TLIF provides good outcomes in the treatment of RLDP, but TLIF is much safer, which is a ideal method to treat RLDP. |
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