[The anatomic study and clinical significance of the modified transforaminal lumbar interbody fusion].
OBJECTIVE
To put some improvements to the traditional transforaminal lumbar interbody fusion (TLIF) and discuss its clinical significance.


METHODS
Completed the traditional posterior lumbar interbody fusion (PLIF) and TLIF procedure in 12 fresh cadavers, dissect further to expose the surrounding anatomical structures, and put the modified TLIF surgery according to the anatomical findings. And simulated the operation in 12 fresh cadavers, analyzed its feasibility and potential advantages.


RESULTS
The early anatomical study found that the related nerve root was in a state of high tension and certain risk of injury when completed the traditional PLIF and TLIF surgery, and found certain operational area between the superior articular process and the midline structures of the spinous processes and interspinous ligaments. Put the modified TLIF surgical approach according to the anatomical findings, which the operating area is located in PLIF outside and TLIF inside. As the following words: Take a posterior-middle incision, preserve the supraspinous and interspinous ligaments, and the spinous processes, dissect the bilateral paravertebral muscle, expose lamina and facet joints, not including transverse process, and remove unilateral inferior two third lamina, inferior articular process and expose the articular surface of the superior articular process, then dispose the intervertebral space for interbody fusion obliquely in the unilateral approach. Successfully completed the modified TLIF procedure in 12 fresh cadavers, the results showed that the technique has the following advantages. (1) Only remove unilateral inferior two third lamina and inferior articular process, preserve the supraspinous and interspinous ligaments, and the spinous processes, not expose the transverse process. (2) Both central canal, and lateral recess and nerve root canal of the operative side can be decompressed effectively simultaneously. (3) Avoid excessive traction to the thecal sac and traversing nerve roots and decrease the injury rate due to the reservation of the midline structures and the oblique manipulation, and less injury rate of the exiting nerve root, because of not necessary to expose it routinely.


CONCLUSIONS
The modified TLIF is safe and feasible, could effectively reduce the nerve roots injuries. Maybe it's a better choice for most of the Chinese patients at present.
Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai 200040, China. jjy@fudanspine.com
Jian-yuan
JY
Jiang
Xin
X
Ma
Fei-zhou
FZ
Lü
Hong-li
HL
Wang
Wen-jun
WJ
Chen
Xiao-sheng
XS
Ma
Xin-lei
XL
Xia
D001344:Autopsy; D006801:Humans; D008159:Lumbar Vertebrae / Q000033:anatomy & histology* / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*