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A modified procedure of single-level transforaminal lumbar interbody fusion reduces immediate post-operative symptoms: a prospective case-controlled study based on two hundred and four cases

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Abstract

Study design

This is a prospective case-controlled study.

Purpose

The purpose of this study is to investigate the effect of a modified transforaminal lumbar interbody fusion (TLIF) on the immediate post-operative symptoms in patients with lumbar disc herniation (LDH) accompanied with stenosis.

Methods

A total of 204 LDH patients with single-level TLIF were enrolled. According to the sequence of the placement of rods and cage, patients were divided into group R (rod-prior-to-cage) and group C (cage-prior-to-rod). Neurological function was evaluated by the Japanese Orthopedic Association (JOA) score. Radiological assessment includes height of intervertebral space (HIS), foraminal height (FH), foraminal area (FA), and segmental lordosis (SL). Change of original symptoms (pain/numb) and new-onset symptoms (pain/numb) after surgery were also recorded.

Results

Patients in group R had less change of HIS at L3/4, L4/5, and L5/S1 levels compared with pre-operation (all p > 0.05), whereas group C had larger change (all p < 0.05). No statistical difference was found in FH between the two groups before and after surgery at L3/4, L4/5, and L5/S1, respectively (all p > 0.05). In terms of FA, patients in group R had better improvement after surgery than those in group C at L3/4 and L4/5 (both p < 0.05). Patients in both groups acquired good improvement of neurological function. However, there were fewer patients in group R who experienced post-operative leg pain or numb compared with those in group C (p < 0.05).

Conclusion

The modified open TLIF can significantly reduce the incidence of immediate post-operative symptoms for patients with single-level lumbar disc herniation via installation of rods prior to insertion of cage and the “neural standard” should serve as the goal of decompression for spine surgeons to restore disc/foraminal height and to minimize nerve distraction.

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Funding

The study is supported by the National Natural Science Foundation of China Grant/Award Numbers 81871828 (Jiangang Shi), 81802218 (Jingchuan Sun), and 81702141 (Ximing Xu).

Author information

Author notes

  1. Kaiqiang Sun, Xiaofei Sun, Le Huan and Ximing Xu contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People’s Republic of China

    Kaiqiang Sun, Xiaofei Sun, Le Huan, Ximing Xu, Jingchuan Sun, Shunmin Wang, Bin Zhang, Bing Zheng, Yongfei Guo & Jiangang Shi

  2. Department of Emergency and Critical Care, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People’s Republic of China

    Liwei Duan

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  1. Kaiqiang Sun
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  2. Xiaofei Sun
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  3. Le Huan
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  4. Ximing Xu
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Correspondence to Yongfei Guo or Jiangang Shi.

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Sun, K., Sun, X., Huan, L. et al. A modified procedure of single-level transforaminal lumbar interbody fusion reduces immediate post-operative symptoms: a prospective case-controlled study based on two hundred and four cases. International Orthopaedics (SICOT) 44, 935–945 (2020). https://doi.org/10.1007/s00264-020-04508-x

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