Modified TLIF Versus Traditional TLIF For Far Lateral Lumbar Disc Herniation In The Elderly

Objective:To compare the treatment effect of modified TLIF(TLIF with unilateral pedicle screw fixation)with traditional TLIF(TLIF with bilateral pedicle screw fixation)for far lateral lumbar disc herniation in the elderly.Data and Methods:1.general information: Form September 2009 to February 2011,The data of 22 cases of FLLDH were analyzed retrospectively, consisting of 13 males and 9 females, aging from 60 to 73 years,with an average age of 66.18±3.38 months.The mean course of their disease was 17.23±8.52 months, range from 3 to 38 months. 2.Methods:we arranged the patients to modified TLIF and traditional TLIF by randomize.In the modified TLIF group,there are 6 males and 4 females,aging from 60 to 71 years,with an average age of 65.70±3.59years;The mean course of their disease was 16.90±8.84 months, range from 3 to 36 months;The lesion affected levels:L_3/4 4 case, L_4/5 5 cases,L₅/S₁ 1 cases.In the group of modified TLIF,there are 7 males and 5 females,aging from 62 to 73 years,with an average age of 66.58±3.29 years;The mean course of their disease was 17.50±8.63 months, range from 6 to 38 months;The lesion affected levels:L_2/3 1case, L_3/4 3 case, L_4/56 cases,L₅/S₁ 2 cases.Results :22 cases were followed up after operation for 3 to 11 months with an average of 7.45±2.40 months. Clinical outcomes were assessed by VAS scores and JoA questionaires before and after operations.For the modified TLIF and traditional TLIF groups both,there were significant differences between the pre-operations and the 3-month after-operations(P<0.001).But there were no significant differences between the two groups when contrast the 3-month after-operations (P>0.05).The excellent and good rate was 90.00% in modified TLIF group and 91.67% in traditional TLIF group(P>0.05).The fusion rate was 100.00% in modified TLIF group and 91.67% in traditional TLIF group(P>0.05) by lumbar X-ray reexamination in 6 months after operation.The operation time(129.00±18.83,176.67±15.86)min,the blood loss(339.00±39.29,555.83±99.95)mL, treatment costs(19194.55±352.03,25398.00±478.72)yuan,mobile time(14.70±2.21 30.42±0.51)days,all the four indices above had significant differences between modified TLIF and traditional TLIF (P<0.001).Conclusion:The technique of the modified TLIF has a good clinical effect on the treatment for the far lateral lumbar disc herniation in the elderly.Because little surgical trauma,bleeding less,no destruction of the contralateral structure,short operation time , low costs , short bed time , significantly reduced risk for perioperation.Most of the patients can obtain satisfactory recent clinical effect.The long term effects remain to be analyzed.