Our Summary

This research paper looks into a type of back surgery called unilateral transforaminal lumbar interbody fusion (or TLIF for short), where a single cage is used to stabilize the spine. The study aimed to understand why some patients experience nerve pain on the opposite side of the body after the surgery and how to prevent it.

The researchers looked back at the medical records of 190 patients who had this surgery between January 2017 and January 2019. They studied X-ray images taken before and after the surgery to measure how different parts of the spine changed. They also recorded patients’ pain levels.

They found that 5.3% of patients (10 out of 190) experienced nerve pain on the opposite side after the surgery. The most common cause was a narrowing of the space where nerves exit the spine (foraminal stenosis) on the opposite side. The surgery could increase the curve in the lower back, the angle between vertebrae, and the height of the front part of the disc between vertebrae, but it could decrease the height of the back part of the disc, the height, and area of the space where nerves exit the spine. This could result in nerve pain on the opposite side.

To prevent this, the researchers suggest that the cage used in the surgery should be placed in a specific way and the height of the disc can be increased to widen the space for nerves on the opposite side. They also stress the importance of careful planning before the surgery. Without it, the surgery can lead to unwanted changes in the spine and result in nerve pain on the opposite side.

FAQs

  1. What is the most common cause of contralateral radiculopathy following unilateral TLIF?
  2. How can the intervertebral cage be placed to prevent contralateral radiculopathy?
  3. What changes in radiological parameters are observed in patients with symptomatic contralateral radiculopathy after undergoing unilateral TLIF?

Doctor’s Tip

One helpful tip a doctor might tell a patient about lumbar fusion is to ensure proper preoperative planning and placement of the intervertebral cage. It is important to have the cage cover the epiphyseal ring and cortical compact bone of the midline, and to increase the disc height to enlarge the contralateral foramen. This can help prevent complications such as contralateral radiculopathy and improve outcomes following unilateral TLIF surgery.

Suitable For

Patients who are typically recommended for lumbar fusion include those with severe back pain, leg pain, or weakness due to conditions such as degenerative disc disease, spondylolisthesis, spinal stenosis, or spinal fractures. These patients may have tried conservative treatments such as physical therapy, medications, and injections without success. Additionally, patients who have instability in the spine or have had previous failed back surgeries may also be candidates for lumbar fusion. It is important for patients to undergo thorough evaluation and preoperative planning to ensure successful outcomes and minimize the risk of complications such as contralateral radiculopathy.

Timeline

Before lumbar fusion:

  • Patient experiences chronic lower back pain, leg pain, and numbness or weakness in the legs
  • Patient undergoes imaging tests such as X-rays, MRI, or CT scans to diagnose the spinal condition
  • Patient may try conservative treatments such as physical therapy, medications, and injections to manage symptoms

After lumbar fusion:

  • Patient undergoes unilateral TLIF surgery to address the spinal condition
  • Postoperatively, patient may experience temporary pain, discomfort, and limited mobility
  • Patient undergoes physical therapy and rehabilitation to regain strength and function
  • Patient follows up with their surgeon for monitoring and assessment of fusion progress
  • Patient may experience contralateral radiculopathy (5.3% incidence) due to factors such as contralateral foraminal stenosis
  • Proper placement of the intervertebral cage and careful preoperative planning are important for successful outcomes

What to Ask Your Doctor

  1. What is the likelihood of experiencing contralateral radiculopathy following unilateral TLIF surgery?
  2. What are the potential causes of contralateral radiculopathy after unilateral TLIF?
  3. How can preoperative planning help prevent contralateral radiculopathy after unilateral TLIF?
  4. What specific radiological parameters should be taken into consideration before undergoing unilateral TLIF?
  5. What are the symptoms of contralateral radiculopathy and how can it be diagnosed?
  6. What steps can be taken during surgery to decrease the risk of contralateral radiculopathy?
  7. What is the expected recovery process and timeline for patients who develop contralateral radiculopathy after unilateral TLIF?
  8. Are there any specific postoperative care instructions or precautions that should be followed to prevent contralateral radiculopathy?
  9. What are the potential long-term effects of contralateral radiculopathy if left untreated?
  10. Are there any alternative treatment options available for patients who are at a higher risk of developing contralateral radiculopathy after unilateral TLIF?

Reference

Authors: Chen YL, Hu XD, Wang Y, Jiang WY, Ma WH. Journal: J Int Med Res. 2021 Aug;49(8):3000605211037475. doi: 10.1177/03000605211037475. PMID: 34461766