Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Acute Contralateral Radiculopathy after Unilateral Transforaminal Lumbar Interbody Fusion

  • Jang, Kyoung-Min (Department of Neurosurgery, College of Medicine, Chung-Ang University) ;
  • Park, Seung-Won (Department of Neurosurgery, College of Medicine, Chung-Ang University) ;
  • Kim, Young-Baeg (Department of Neurosurgery, College of Medicine, Chung-Ang University) ;
  • Park, Yong-Sook (Department of Neurosurgery, College of Medicine, Chung-Ang University) ;
  • Nam, Taek-Kyun (Department of Neurosurgery, College of Medicine, Chung-Ang University) ;
  • Lee, Young-Seok (Department of Neurosurgery, College of Medicine, Chung-Ang University)
  • Received : 2015.07.01
  • Accepted : 2015.10.12
  • Published : 2015.10.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Cases of contralateral radiculopathy after a transforaminal lumbar interbody fusion with a single cage (unilateral TLIF) had been reported, but the phenomenon has not been explained satisfactorily. The purpose of this study was to determine its incidence, causes, and risk factors. Methods : We did retrospective study with 546 patients who underwent a unilateral TLIF, and used CT and MRI to study the causes of contralateral radicular symptoms that appeared within a week postoperatively. Clinical and radiological results were compared by dividing the patients into the symptomatic group and asymptomatic group. Results : Contralateral symptoms occurred in 32 (5.9%) of the patients underwent unilateral TLIF. The most common cause of contralateral symptoms was a contralateral foraminal stenosis in 22 (68.8%), screw malposition in 4 (12.5%), newly developed herniated nucleus pulposus in 3 (9.3%), hematoma in 1 (3.1%), and unknown origin in 2 patients (6.3%). 16 (50.0%) of the 32 patients received revision surgery. There was no difference in visual analogue scale and Oswestry disability index between the two groups at discharge. Both preoperative and postoperative contralateral foraminal areas were significantly smaller, and postoperative segmental angle was significantly greater in the symptomatic group comparing to those of the asymptomatic group (p<0.05). Conclusion : The incidence rate is not likely to be small (5.9%). If unilateral TLIF is performed for cases when preoperative contralateral foraminal stenosis already exists or when a large restoration of segmental lordosis is required, the probability of developing contralateral radiculopathy is increased and caution from the surgeon is needed.

Keywords

References

  1. Barnes B, Rodts GE Jr, Haid RW Jr, Subach BR, McLaughlin MR : Allograft implants for posterior lumbar interbody fusion : results comparing cylindrical dowels and impacted wedges. Neurosurgery 51 : 1191-1198; discussion 1198, 2002 https://doi.org/10.1097/00006123-200211000-00014
  2. Blume H, Rojas C : Unilateral lumbar interbody fusion (posterior approach) utilizing dowel graft. J Neurol Orthop Surg 2 : 171-175, 1981
  3. Chiang MF, Zhong ZC, Chen CS, Cheng CK, Shih SL : Biomechanical comparison of instrumented posterior lumbar interbody fusion with one or two cages by finite element analysis. Spine (Phila Pa 1976) 31 : E682-E689, 2006 https://doi.org/10.1097/01.brs.0000232714.72699.8e
  4. Cutler AR, Siddiqui S, Mohan AL, Hillard VH, Cerabona F, Das K : Comparison of polyetheretherketone cages with femoral cortical bone allograft as a single-piece interbody spacer in transforaminal lumbar interbody fusion. J Neurosurg Spine 5 : 534-539, 2006 https://doi.org/10.3171/spi.2006.5.6.534
  5. DiPaola CP, Molinari RW : Posterior lumbar interbody fusion. J Am Acad Orthop Surg 16 : 130-139, 2008 https://doi.org/10.5435/00124635-200803000-00004
  6. Elias WJ, Simmons NE, Kaptain GJ, Chadduck JB, Whitehill R : Complications of posterior lumbar interbody fusion when using a titanium threaded cage device. J Neurosurg 93 (1 Suppl) : 45-52, 2000
  7. Farcy JP, Schwab FJ : Management of flatback and related kyphotic decompensation syndromes. Spine (Phila Pa 1976) 22 : 2452-2457, 1997 https://doi.org/10.1097/00007632-199710150-00025
  8. Fogel GR, Toohey JS, Neidre A, Brantigan JW : Is one cage enough in posterior lumbar interbody fusion : a comparison of unilateral single cage interbody fusion to bilateral cages. J Spinal Disord Tech 20 : 60-65, 2007 https://doi.org/10.1097/01.bsd.0000211251.59953.a4
  9. Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F : The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 30 : 2024-2029, 2005 https://doi.org/10.1097/01.brs.0000179086.30449.96
  10. Goz V, Weinreb JH, Schwab F, Lafage V, Errico TJ : Comparison of complications, costs, and length of stay of three different lumbar interbody fusion techniques : an analysis of the Nationwide Inpatient Sample database. Spine J 14 : 2019-2027, 2014 https://doi.org/10.1016/j.spinee.2013.11.050
  11. Hackenberg L, Halm H, Bullmann V, Vieth V, Schneider M, Liljenqvist U : Transforaminal lumbar interbody fusion : a safe technique with satisfactory three to five year results. Eur Spine J 14 : 551-558, 2005 https://doi.org/10.1007/s00586-004-0830-1
  12. Harms JG, Jeszenszky D : The unilateral, transforaminal approach for posterior lumbar interbody fusion. Orthop Traumatol 6 : 88-99, 1998
  13. Hasegawa T, An HS, Haughton VM, Nowicki BH : Lumbar foraminal stenosis : critical heights of the intervertebral discs and foramina. A cryomicrotome study in cadavera. J Bone Joint Surg Am 77 : 32-38, 1995 https://doi.org/10.2106/00004623-199501000-00005
  14. Hey HW, Hee HT : Lumbar degenerative spinal deformity : surgical options of PLIF, TLIF and MI-TLIF. Indian J Orthop 44 : 159-162, 2010 https://doi.org/10.4103/0019-5413.62066
  15. Houten JK, Post NH, Dryer JW, Errico TJ : Clinical and radiographically/neuroimaging documented outcome in transforaminal lumbar interbody fusion. Neurosurg Focus 20 : E8, 2006 https://doi.org/10.3171/foc.2006.20.4.5
  16. Hsieh PC, Koski TR, O'Shaughnessy BA, Sugrue P, Salehi S, Ondra S, et al. : Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion : implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance. J Neurosurg Spine 7 : 379-386, 2007 https://doi.org/10.3171/SPI-07/10/379
  17. Hu SS, Tribus CB, Diab M, Ghanayem AJ : Spondylolisthesis and spondylolysis. J Bone Joint Surg Am 90 : 656-671, 2008
  18. Humphreys SC, Hodges SD, Patwardhan AG, Eck JC, Murphy RB, Covington LA : Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine (Phila Pa 1976) 26 : 567-571, 2001 https://doi.org/10.1097/00007632-200103010-00023
  19. Hunt T, Shen FH, Shaffrey CI, Arlet V : Contralateral radiculopathy after transforaminal lumbar interbody fusion. Eur Spine J 16 Suppl 3 : 311-314, 2007 https://doi.org/10.1007/s00586-007-0387-x
  20. Iwata T, Miyamoto K, Hioki A, Fushimi K, Ohno T, Shimizu K : Morphologic changes in contralateral lumbar foramen in unilateral cantilever transforaminal lumbar interbody fusion using kidney-type intervertebral spacers. J Spinal Disord Tech 28 : E270-E276, 2015 https://doi.org/10.1097/BSD.0b013e318286bb14
  21. Jang JS, Lee SH, Min JH, Kim SK, Han KM, Maeng DH : Surgical treatment of failed back surgery syndrome due to sagittal imbalance. Spine (Phila Pa 1976) 32 : 3081-3087, 2007 https://doi.org/10.1097/BRS.0b013e31815cde71
  22. Kim CW, Siemionow K, Anderson DG, Phillips FM : The current state of minimally invasive spine surgery. J Bone Joint Surg Am 93 : 582-596, 2011
  23. Kim JT, Shin MH, Lee HJ, Choi DY : Restoration of lumbopelvic sagittal alignment and its maintenance following transforaminal lumbar interbody fusion (TLIF) : comparison between straight type versus curvilinear type cage. Eur Spine J, 2015 [Epub ahead of print]
  24. Kim SB, Jeon TS, Heo YM, Lee WS, Yi JW, Kim TK, et al. : Radiographic results of single level transforaminal lumbar interbody fusion in degenerative lumbar spine disease : focusing on changes of segmental lordosis in fusion segment. Clin Orthop Surg 1 : 207-213, 2009
  25. Lee CK, Park JY, Zhang HY : Minimally invasive transforaminal lumbar interbody fusion using a single interbody cage and a tubular retraction system : technical tips, and perioperative, radiologic and clinical outcomes. J Korean Neurosurg Soc 48 : 219-224, 2010 https://doi.org/10.3340/jkns.2010.48.3.219
  26. Lee YS, Kim YB, Park SW, Chung C : Comparison of transforaminal lumbar interbody fusion with direct lumbar interbody fusion : clinical and radiological results. J Korean Neurosurg Soc 56 : 469-474, 2014 https://doi.org/10.3340/jkns.2014.56.6.469
  27. Molinari RW, Gerlinger T : Functional outcomes of instrumented posterior lumbar interbody fusion in active-duty US servicemen : a comparison with nonoperative management. Spine J 1 : 215-224, 2001 https://doi.org/10.1016/S1529-9430(01)00015-8
  28. Mummaneni PV, Dhall SS, Eck JC, Groff MW, Ghogawala Z, Watters WC 3rd, et al. : Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 11 : interbody techniques for lumbar fusion. J Neurosurg Spine 21 : 67-74, 2014 https://doi.org/10.3171/2014.4.SPINE14276
  29. Potter BK, Freedman BA, Verwiebe EG, Hall JM, Polly DW Jr, Kuklo TR : Transforaminal lumbar interbody fusion : clinical and radiographic results and complications in 100 consecutive patients. J Spinal Disord Tech 18 : 337-346, 2005 https://doi.org/10.1097/01.bsd.0000166642.69189.45
  30. Schwab F, Patel A, Ungar B, Farcy JP, Lafage V : Adult spinal deformitypostoperative standing imbalance : how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976) 35 : 2224-2231, 2010 https://doi.org/10.1097/BRS.0b013e3181ee6bd4
  31. Smith A, O'Sullivan P, Straker L : Classification of sagittal thoraco-lumbo-pelvic alignment of the adolescent spine in standing and its relationship to low back pain. Spine (Phila Pa 1976) 33 : 2101-2107, 2008 https://doi.org/10.1097/BRS.0b013e31817ec3b0
  32. Yan DL, Pei FX, Li J, Soo CL : Comparative study of PILF and TLIF treatment in adult degenerative spondylolisthesis. Eur Spine J 17 : 1311-1316, 2008 https://doi.org/10.1007/s00586-008-0739-1

Cited by

  1. Comparison of Clinical and Radiological Outcomes of Lumbar Interbody Fusion Using a Combination of Hydroxyapatite and Demineralized Bone Matrix and Autografts for Lumbar Degenerative Spondylolisthesis vol.11, pp.5, 2015, https://doi.org/10.4184/asj.2017.11.5.706
  2. Risk factor of contralateral radiculopathy following microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion vol.27, pp.8, 2018, https://doi.org/10.1007/s00586-017-5417-8
  3. Morphological changes of contralateral intervertebral foramen induced by cage insertion orientation after unilateral transforaminal lumbar interbody fusion vol.14, pp.None, 2019, https://doi.org/10.1186/s13018-019-1121-1
  4. Risk Factors for Symptomatic Contralateral Foraminal Stenosis After Unilateral Transforaminal Lumbar Interbody Fusion vol.133, pp.None, 2020, https://doi.org/10.1016/j.wneu.2019.09.048
  5. A Transforaminal Endoscopic Surgical Technique for Treating Lumbar Disc Herniation in the Setting of Spina Bifida vol.2020, pp.None, 2020, https://doi.org/10.1155/2020/1076847
  6. CHANGES IN THE LUMBAR VERTEBRAL SEGMENT RELATED TO THE CAGE POSITION IN TLIF TECHNIQUE vol.28, pp.2, 2020, https://doi.org/10.1590/1413-785220202802224215
  7. Contralateral radiculopathy after unilateral transforaminal lumbar interbody fusion: causes and prevention vol.49, pp.8, 2015, https://doi.org/10.1177/03000605211037475