Modified Transforaminal Lumbar Interbody Fusion For The Treatment Of Lumbar Degenerative Disease

Objective:To analyze the clinical effects of modified Transforaminal Lumbar InterbodyFusion(TLIF) for the treatment of lumbar degenerative disease.Methods：From June2009to March2010,33patients with lumbar degenerativedisease(L3-S1)were treated by modified TLIF.There were14males and19females withan average age of52.2years(45to70years).The average disease course was16months(4months to36months).A total of42levels were fused,including24cases of singlelevel and9cases of double levels.The results of preoperative diagnosis were lumbardegenerative spondylolisthesis with stenosis(8cases),isthmic spondylolisthesis(5cases),degenerative lumbar stenosis(16cases),huge herniated disc with segmentalinstability(3cases)and failed back surgery syndrome(1case).During the modified TLIFprocedure,unilateral total inferior facet process and inner half summit of superior facetprocess of TLIF side were resected to make the posterior wall of foramen openedpartly.After the bone graft(5mL)was placed into the interbody space,a single rectangleCage was inserted obliquely from30°to40°toward the midline.Combined with pediclescrew instrumentation,TLIF was accomplished.Middle canal and opposite side nerveroot decompression were performed simultaneously when necessary.Results:Intraoperative duramater rupture,postoperative cerebral spinal fluid leakage,deepwound infection and transient nerve root stimulation occurred in1case respectively,andwere all recovered after treatment.No patients had permanent neurologic deficit oraggravation.All patients were followed up for15to30months.At the follow-up after1year postoperatively,all the operated segments achieved fusion standard and no broken screw or Cage dislocation occurred.All13cases of spondylolisthesis were reducedthoroughly and maintained satisfactorily.Nineteen patients remained slight chronic backpain.There was significant difference(P<0.05)in JOA score betweenpreoperation(14.9±5.1)and postoperation(25.9±3.0).The rate of clinical improvementwas93.9%(excellent in24cases,good in7cases,and fair in2cases).Conclusion:The modified TLIF carries out the less invasive principles in opening operationsexpands the indication of TLIF to some extent,and the clinical results for the treatmentof lumbar degenerative disease is satisfactory.