Transforaminal Lumbar Interbody Fusion Using A Modified Distractor Handle:a Midterm Clinico-radiological Follow-up Study

Objective:The choice of the cage size for transforaminal interbody fusion (TLIF) is usually empirical. This study examined the safety and effectiveness of TLIF performed with a modified distractor handle for the cage-size decision.Methods:Forty-five consecutive patients with lumbar degenerative disease (LDD) who underwent unilateral instrumented TLIF between March 2009 and March 2010 were enrolled in this retrospective study. Cage size was determined with a self-made modified distractor handle. Clinical outcomes were assessed with the Oswestry Disability Index (ODI) and a visual analog scale (VAS) for low back pain. Bony fusion was verified by dynamic lateral lumbar radiography at 6,12, and 24 months after TLIF.Results:The tension of the modified distractor handle ranged from 2 to 4 N in determining the cage size. All cages were successfully implanted in a single attempt. The mean operative time was 92.3±34.5 minutes (range,80-145 minutes). The mean intraoperative bleeding volume was 120.4±40.4 mL (95-160 mL). Postoperative recovery was uneventful for all patients. The ODI and VAS scores and the mean height of the intervertebral space improved/increased significantly after TLIF as compared to the baselines. Radiological bony fusion rates were 91.6% and 100.0% 12 and 24 months, respectively, after TLIF. Follow-up radiography revealed no case of cage migration or endplate collapse.Conclusion:Use of the modified distractor handle for the cage-size decision in TLIF shows favorable effectiveness and safety results in the treatment of LDD.