Transforaminal Lumbar Interbody Fusion With Unilateral Pedicle Screw Fixation In The Treatment Of Middle And Old Age Patients With Single Level Lumbar Disc Herniation And A Middle Term Follow-up

Objective:Analysis and review of the middle term outcomes of transforaminal lumbar interbody fusion with unilateral pedicle screw fixation in the treatment of middle and old age patients with single level lumbar disc herniation.Methods:From January 2011 to January 2013,TLIF with unilateral pedicle screw fixation was performed for consecutive cohort of 49 middle and old age patients with single level lumbar disc herniation.There were 29 males,20 females,age from 35 to 74,average(51.3±12.7)years old,preoperative duration of 3~26months,all the patients are diagnosed with single level lumbar disc herniation and performed with single level operation.The operation level at L3-4 for 6 patients,L4-5for 23 patients,L5-S1 for 20 patients.All of the 49 patients have finished radiographic examinations and questionnaires before and after the operations.According to the Japanese Orthopedic Association score(JOA),Visual Analogue Score(VAS)and Oswestry Disability Index(ODI)in the questionnaires,the intervertebral disc heights of the operational sides and nonoperational sides,the intervertebral disc heights of the upper adjacent segment before the operations and in the follow-ups,to evaluate the recoveries of physical dysfunctions and the relief of the nerve compression.Result:All the patients have fininshed the follow-up investigations.The average years of the follow-ups are 2.8±1.2 years.All the incisions healed well primarily withoutinfections,no instrumentation loosed or broken and no Cages shifted.The symptoms of all the patients alleviated apparently in the investigations of follow-ups.The average JOA scores of all the patients before operation are 8.1±2.5 points,three months later after the operation are 21.8±2.2 points,23.4±2.5 points in the last follow-up.The average VAS scores of all the patients before operation are 7.8±0.9 points,three months later after the operation are 2.3±0.6 points,1.9±0.8 points in the last follow-up.The average ODI scores of all the patients before operation are45.8±1.8 points,three months later after the operation are 12.7±2.6 points,8.6±2.7 points in the last follow-up.Compared with the three preoperative indexes,all show significant improvement in the follow-ups after three months of the operation and the last follow-ups,and the differences have great statistical significance(P<0.01).Among all the 49 patients,22 patients show significant therapeutic effect,20 patients show therapeutic effect,4 patients without significant therapeutic effect,the goodrate of the improvement is 85.7%.Compared the intervertebral disc heights of the operational sides and nonoperational sides,none show statistical significance(P>0.05)before the operation,in the follow-ups after three months of the operation and the last follow-ups,which point out this kind of operation will not bring about iatrogenic scoliosis.The intervertebral disc heights of the upper adjacent levels decreased at different degrees in the follow-ups after three months of the operation and the last follow-ups,but without statistical significance(P>0.05)compared with the measurements before operations.Conclusions:Through the comparisonswe can comfirm that transforaminal lumbar interbody fusion with unilateral pedicle screw fixation plays a significant role in the improvement of nervous function in the middle and old age patients with single level lumbar disc herniation.,this kind of operation comformed with little surgical trauma,low complication rates,and good middle term efficacy.