Jiann-Her Lin1, Yung-Hsiao Chiang2. 1. Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan. 2. Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan. Electronic address: jiannherlin@gmail.com.
Abstract
OBJECTIVE: To evaluate the efficiency and safety of a unilateral approach for bilateral foramen decompression in minimally invasive transforaminal lumbar interbody fusion (miTLIF) for the treatment of bilateral foraminal stenosis. METHODS: Treatment of 52 levels of bilateral foraminal stenosis in 48 patients was performed using a unilateral approach for bilateral foramen decompression in miTLIF. The foramen areas on bilateral sides, the cross-sectional areas of the dura mater, and the structural preservation of the multifidus muscle on bilateral sides were compared preoperatively and 1 year postoperatively. Visual analog scale scores of pain, 36-item short form health survey results, and complications were recorded after reviewing patient charts. Fusion rates were evaluated 1 year postoperatively. RESULTS: The average age of patients was 62.48 years. The mean follow-up period was 12.78 months. The foramen areas on bilateral sides and the cross-sectional area of the dura mater increased significantly postoperatively (P < 0.05). Structural preservation of the multifidus muscle was observed in 20 of 54 levels (37%) on ipsilateral sides and in 48 of 54 levels (89%) on contralateral sides. No major complications were observed, and the incidences of minor complications and incidental durotomy were 28% and 4%, respectively. Improvements in average visual analog scale pain and 36-item short form health survey 6 (preoperative to 1 year postoperatively) scores were from 5.9 to 1.8 (P < 0.05) and from 51.3 to 71.3 (P < 0.01), respectively. The radiologic criteria of bony fusion were met by 40 patients (83%). CONCLUSIONS: A unilateral approach for bilateral foramen decompression in miTLIF provides a safe and efficient method for the treatment of bilateral foramen stenosis in patients with degenerative spinal disorders.
OBJECTIVE: To evaluate the efficiency and safety of a unilateral approach for bilateral foramen decompression in minimally invasive transforaminal lumbar interbody fusion (miTLIF) for the treatment of bilateral foraminal stenosis. METHODS: Treatment of 52 levels of bilateral foraminal stenosis in 48 patients was performed using a unilateral approach for bilateral foramen decompression in miTLIF. The foramen areas on bilateral sides, the cross-sectional areas of the dura mater, and the structural preservation of the multifidus muscle on bilateral sides were compared preoperatively and 1 year postoperatively. Visual analog scale scores of pain, 36-item short form health survey results, and complications were recorded after reviewing patient charts. Fusion rates were evaluated 1 year postoperatively. RESULTS: The average age of patients was 62.48 years. The mean follow-up period was 12.78 months. The foramen areas on bilateral sides and the cross-sectional area of the dura mater increased significantly postoperatively (P < 0.05). Structural preservation of the multifidus muscle was observed in 20 of 54 levels (37%) on ipsilateral sides and in 48 of 54 levels (89%) on contralateral sides. No major complications were observed, and the incidences of minor complications and incidental durotomy were 28% and 4%, respectively. Improvements in average visual analog scale pain and 36-item short form health survey 6 (preoperative to 1 year postoperatively) scores were from 5.9 to 1.8 (P < 0.05) and from 51.3 to 71.3 (P < 0.01), respectively. The radiologic criteria of bony fusion were met by 40 patients (83%). CONCLUSIONS: A unilateral approach for bilateral foramen decompression in miTLIF provides a safe and efficient method for the treatment of bilateral foramen stenosis in patients with degenerative spinal disorders.