title: Instrumented transforaminal lumbar interbody fusion in surgical treatment of recurrent disc herniation.
abstract: BACKGROUND
  The incidence of recurrence in patients undergoing primary discectomy due to lumbar disc herniation (LDH), is regularly reported as 5-15%. In this study we aimed to evaluate surgical outcome of instrumented transforaminal lumbar interbody fusion (TLIF) in the patients suffering from recurrent LDH.
  
  
  METHODS
  We retrospectively studied 51 patients (30 female, 21 male) from August 2007 to October 2011. The mean age and follow-up of the patients was 46.4±14.8 (ranged; 29-77 years old) and 31.4±6.8 (ranged; 25-50 months), respectively. Clinical improvement was assessed by Oswestry Disability Index (ODI), visual analogue scale (VAS), and subjective satisfaction rate, while fusion was appraised radiologically. Data analysis was by one sample Kolmogorov-Smirnov, paired t, and Mann-Whitney tests.
  
  
  RESULTS
  Surgery could significantly improve mean leg and lumbar VAS and ODI from preoperative 7.4±2.5, 7.8±3.1, and 72.1±21.5 to postoperative 3.4±3.6, 3.5±2.6, and 27.5±18.0, respectively at the last follow-up visit. Subjective satisfaction rate was excellent in 24 patients (47.1%), good in 14 (27.5%), fair 11 (21.6%), and poor in two (3.9%). We had one patient with iatrogenic partial L5 nerve root injury and one with unknown late onset refractory postoperative back pain. Fusion rate was 100% and instrument failure was nil.
  
  
  CONCLUSIONS
  In surgical treatment of the patients with recurrent LDH, bilaterally instrumented TLIF is a relatively safe and effective procedure and can be associated with least instrument failure and highest fusion rate while no postoperative bracing is also needed.
authors: 1. Associate Professor of Orthopedic Surgery, Orthopedic Department, Orthopedic Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. omidif@mums.ac.ir.
authors: Farzad
authors: F
authors: Omidi-Kashani
authors: 2. Professor of Orthopedic Surgery, Orthopedic Department, Orthopedic Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. hasankhanie@mums.ac.ir.
authors: Ebrahim
authors: E
authors: Ghayem Hasankhani
authors: 3. Orthopedic Resident, Orthopedic Department, Orthopedic Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. noroozi_hr6@gmail.com.
authors: Hamid Reza
authors: HR
authors: Noroozi
keywords: Recurrent disc herniation; Transforaminal lumbar interbody fusion; Treatment outcome