Journal of Neurological Sciences (Turkish) Ahead Of Print
Concomitant symptomatic thoracolumbar and lower lumbar disc herniations: Strategies for treatment and outcomes
Lai-Qing Sun1, Yong Shen1, ,Jun-Ming Cao1
1The Third Hospital of Hebei Medical University, Department of Spine Surgery, Shijiazhuang,
DOI : 10.24165/jns.5412.13 Background The purpose of this article was to discuss the strategies for performing surgery at the thoracolumbar and lower lumbar simultaneous along with its outcomes.Method Fourteen consecutive patients with concomitant symptomatic thoracolumbar and lower lumbar disc herniations underwent modified transfacetal pedicle-sparing approach combined with short segmental fusion at the thoracolumbar junction and TlIF(transforaminal lumbar interbody fusion)/PLIF(posterior lumbar interbody fusion)at the lower lumbar from 2008 to 2011. Their clinical and radiological data were collected and analyzed. Preoperative and postoperative clinical symptoms were assessed using the criteria for the evaluation of low back pain treatment outcome proposed by the Japanese Orthopaedic Association(JOA). Results The mean follow-up period was 16 months (range, 11–48 months).There were no dural tears,CSF leaks and neurological deterioration in our patients during operation. The mean JOA score rose from 10.21 preoperatively (range 3–16) to 25.64(range 23–28) postperatively. The mean recovery rate with the JOA score as detailed above was 82.1%.There was a significant difference between preoperative and postoperative JOA score in this series (p<0.0001, Students t test), showing statistically significant improvement at the clinical symptoms and JOA scores. Radiographic fusion was confirmed to be present in all the 14 patients during the follow-up period. Conclusions The modified transfacetal pedicle-sparing approach combined with short segmental fusion, which resulted in satisfactory clinical outcomes with few complications, could be one of the main surgical procedures used to treat thoracolumbar disc herniations when performing surgery at the thoracolumbar and lower lumbar simultaneous Keywords : thoracolumbar disc herniation; lower lumbar disc herniation; transfacetal pedicle-sparing approach; segmental fusion