1.Recurrent Lumbar Disc Herniation: Does Transforaminal Lumbar Interbody Fusion Lead to Better Clinical and Radiological Outcomes than Redo-Discectomy?
Mohamed MOSAAD ; Ali KHOZAMY ; Ahmed Samir BARAKAT ; Ihab EMRAN ; Yasser ELMELIGY ; Alaa ABULHAMD
Asian Spine Journal 2023;17(5):862-869
Methods:
Sixty patients with RDH were randomly divided into two equal groups: the first group underwent revision discectomy alone and the second underwent revision discectomy with fusion. The primary outcomes evaluated were Visual Analog Scale (VAS) for low back and limb pains, Oswestry Disability Index (ODI), disc height indexes, foraminal height index, and disc height subsidence. Secondary outcomes included operative time, blood loss, postoperative hospital stay, and complications.
Results:
Revision discectomy with fusion showed superior pain relief and improved functional outcomes, including better VAS scores for both back and leg pain and ODI at 24-month follow-up. Additionally, it restored the stability of the spine better with lower disc height subsidence without significant complications. However, these advantages came at the cost of increased blood loss and longer operative time and hospital stays.
Conclusions
Revision discectomy with fusion is recommended for RDH; however, the choice of the procedure should be made caseby- case basis, considering many factors related to the patient and surgical facilities.
2.Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Surgical Management of Post-Discectomy Syndrome
Ahmed Bahaa Al Din ALSHAZLI ; Ashraf Yassin AMER ; Ahmed Maher SULTAN ; Ahmed Samir BARAKAT ; Wael KOPTAN ; Yasser ELMILIGUI ; Hesham SHAKER
Asian Spine Journal 2020;14(2):148-156
Methods:
Patients were functionally assessed using the Visual Analog Scale (VAS) for low back pain (LBP) and leg pain (LP) and Oswestry Disability Index (ODI). Radiological fusion was confirmed with plain X-rays and when indicated with computed tomography scan at 12 months postoperatively. A total of 30 patients with 37 operated at lumbar levels with failed discectomy surgery who met our inclusion criteria were treated with MIS-TLIF.
Results:
The ODI of all patients showed significant improvement from a mean of 73.78% preoperatively to 16.67% at 1 month and 14.13% at 12 months postoperatively. The preoperative LBP VAS score (mean, 4.37) showed a significant decrease (p <0.001) to 1.90 at 1 month and 1.10 at 12 months. Preoperative LP VAS score of limb pain averaged 7.53 and showed a significant (p <0.001) decrease to 3.47 at 1 month and 1.10 at 12 months. All patients attained radiological fusion at 12 months.
Conclusions
MIS-TILF constitutes a valid and effective treatment option for patients with post-discectomy syndrome.