Instrumented transforaminal lumbar interbody fusion with single cage for the treatment of degenerative lumbar disease

Abstract

There are several practical problems encountered in the TLIF procedure with implantation of two titanium cages, such as difficulty in achieving symmetric positioning with two cages, loosening of the first cage following insertion of the second cage and higher direct costs to the patient. From January 2005 to December 2007, a total of 76 consecutive patients treated with instrumented TLIF with single cage and excised local bone were enrolled in the current study. There were 45 males and 31 females aged between 31 and 75 years (mean 50.9 years). Forty-five patients had degenerative disc diseases alone, 23 had associated isthmic or degenerative spondylolisthesis and 8 had recurrent disc herniations. Clinical outcomes were evaluated using the Oswestry Disability Index and a visual analog scale. Intervertebral height and fusion status were assessed on X-ray and two-dimensional computed tomography reconstruction. All the patients followed up. The mean follow-up period was 21.8 months (range from 12 to 48 months). No nerve injuries occurred during operation. Postoperative ODI and VAS scores in all the patients were more than the preoperative ones with significant differences. All the patients had complete interbody fusion and, at the final follow-up, none had instrumentation failure. Postoperative intervertebral height in all the patients was better than the preoperative ones with statistical significances. Instrumented TLIF with single cage is a safe and effective method for the treatment of degenerative lumbar diseases.