The Results of Using a Transforaminal Lumbar Interbody Fusion Cage at the Upper Lumbar Level

. 2021 Jun 7;13(6):e15496.


doi: 10.7759/cureus.15496.


eCollection 2021 Jun.

Affiliations

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Uzay Erdoğan.


Cureus.


.

Abstract

Aim The aim of this study is to apply surgical treatments to upper lumbar disc hernias in order to provide lumbar stability and lumbar lordosis using a transforaminal lumbar interbody fusion (TLIF) cage and to preserve the success rate of surgical results by protecting neural structures without excessive subject tension. Material and methods Between 2012 and 2017, 32 patients who had undergone an operation for upper lumbar disc herniation and who had received a transforaminal lumbar interbody fusion cage using a posterior technique were evaluated retrospectively. Results The radiological and clinical findings, surgical methods, and results of the patients were evaluated. In our study, 25 (78.1%) of the patients with upper lumbar disc hernias who were evaluated retrospectively were female and seven (21.9%) were male. Their average age was 55.43 years. The average follow-up was 21.75 months. The most common complaints were lower back pain, leg pain, and claudication. In the findings from neurological examinations, a positive result on the femoral stretching test occurred in 30 (93.7%) patients. In the degenerative spinal structure of patients at the L1-2 and L2-3 levels, a transforaminal lumbar interbody fusion was performed via a wide laminectomy with posterior stabilization due to a wide-bottomed disc hernia and stenosis. Only one of the patients with a neurological deficit still had a motor deficit after surgery. Conclusion While planning a surgery for upper lumbar disc hernias, the anatomical features of this region and the patients’ radiological and neurological findings should be carefully evaluated. If TLIF is performed during upper lumbar region surgery, it may be preferable to perform it using a posterior technique.


Keywords:

disc herniation; interbody cage; lumbar-fusion; transforaminal; upper lumbar.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures


Figure 1



Figure 1. A) Preoperative Dynamic X-ray Images, B) Preoperative CT, C) Preoperative MRI, D) Postoperative Two-Way X-ray Images

A-C: In the preoperative radiological images, it is seen that the adjacent segment, L1-L2 instability, and disc herniation developed in the patient who underwent L2-L3-L4-L5 posterior transpedicular stabilization. D: Since there was fusion in the lower segments, the transpeduncular screws in the lower segment were removed. Transpedicular stabilization of the L1-L2 level was performed with transforaminal interbody cage fusion. It shows the postoperative control X-ray.


Figure 2



Figure 2. A: Postoperative 2nd Year CT, B: Preoperative CT

A: Posterior transpeduncular stabilization and TLIF fusion are seen at the L1-L2 level. B: It is seen that the patient with an adjacent segment has instability at the L1-L2 level.


Figure 3



Figure 3. A: Preoperative Two-Way X-ray images, B: Preoperative CT, C: Preoperative MRI, D: Postoperative Two-Way X-ray Images


Figure 4



Figure 4. A: Postoperative 2nd Year CT, B: Preoperative CT

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