Clinical outcomes of posterior lumbar interbody fusion for lumbar foraminal stenosis: preoperative diagnosis and surgical strategy.
METHODS
A retrospective case study of the use of posterior lumbar interbody fusion (PLIF) to treat lumbar foraminal stenosis (LFS).


OBJECTIVE
To characterize the features of clinical symptoms, radiographic evaluation, and surgical outcomes of PLIF in LFS.


BACKGROUND
There is no gold standard for the surgical treatment of foraminal stenosis, which occurs in 8% to 10% of surgical cases of lumbar degenerative disease.


METHODS
Data from 31 patients (33 segments) who underwent PLIF from 2001 to 2005 at our institution were analyzed. Exclusion criteria included the patients having both LFS and central canal stenosis, plus extraforaminal or intraforaminal disc herniation. There were 22 males and 9 females, with an average age of 61 (31~78 y). The affected levels were as follows: L3/4 in 1 patient, L4/5 in 4, and L5/S1 in 28. All patients underwent PLIF with the combination of segmental pedicle screws, interbody cages, and autogenous local bone graft.


RESULTS
The frequencies of Kemp sign (+), intermittent claudication, leg pain in a sitting position, and leg pain at night, were high. Radiographic evaluation showed severe disc degeneration such as loss of disc height, massive osteophyte formation, and transverse offset angles of the nerve root at the corresponding level. Magnetic resonance imaging and 3D-reconstraction computed tomography clearly showed intraforaminal stenosis in sagittal, axial, and coronal planes. The PLIF procedure provided complete root decompression, restoration of disc height, and preservation of lumbar lordosis at final follow-up. The Japanese Orthopedic Association score improved from 17.1 points preoperatively to 24.9 points at final follow-up, and the overall fusion rate was 100%.


CONCLUSIONS
Lumbar foraminal stenosis could be reliably diagnosed by distinctive clinical symptoms, and various radiographic examinations such as plain x-ray, Magnetic resonance imaging, and 3D-reconstraction computed tomography. The PLIF procedure, in combination with segmental pedicle screws, interbody cages, and autogenous local bone graft provides excellent clinical outcomes, and is a rational and useful surgical option for lumbar foraminal stenosis.
Watanabe
Kei
K
Niigata Central Hospital, 1-18Shinkocho, Chuoku, Niigata City, Niigata, Japan. keiwatanabe_39jp@live.jp
Yamazaki
Akiyoshi
A
Morita
Osamu
O
Sano
Atsuki
A
Katsumi
Keiichi
K
Ohashi
Masayuki
M
D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000295:instrumentation / Q000379:methods*; D011843:Radiculopathy / Q000175:diagnosis / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013130:Spinal Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*