title: Mini-open Anterior Lumbar Interbody Fusion for Recurrent Lumbar Disc Herniation Following Posterior Instrumentation.
abstract: METHODS
  A retrospective study.
  
  
  OBJECTIVE
  The aim of this study is to evaluate, clinically and radiographically, the efficacy of mini-open retroperitoneal anterior lumbar discectomy followed by anterior lumbar interbody fusion (ALIF) for recurrent lumbar disc herniation following primary posterior instrumentation.
  
  
  BACKGROUND
  Recurrent disc herniation following previous disc surgery occurs in 5 to 15% of cases. This is often treated by further surgical intervention where posterior approach is generally preferred. However, posterior surgery may be problematic if the initial surgery involved posterior instrumentation. An anterior approach may be indicated in these patients, and recent findings suggest that a "mini-open" procedure may have some benefits when compared with traditional open techniques and their associated morbidities.
  
  
  METHODS
  A total of 35 recurrent lumbar disc herniation patients (10 male, 25 female) following primary posterior instrumentation with an average age of 52.8 years (range: 34-70 yrs) who underwent the mini-open ALIF procedures between August 2001 and February 2012 were evaluated retrospectively. The ALIF was performed at the levels L4-L5 (n = 14), L5-S1 (n = 15), or both L4-L5 and L5-S1 (n = 6). Visual Analog pain Scale (VAS) and Oswestry Disability Index (ODI) together with radiological results were assessed.
  
  
  RESULTS
  The mean operating time, intraoperative estimated blood loss, and hospital stay were 115 minutes, 70 mL, and 6 days, respectively. No blood transfusion was needed. Transient complication was recorded in two patients. Postoperative follow-up was a minimum 24.3 months. VAS score and ODI percentage decreased significantly from 7.9 ± 0.8 and 78.8% ± 12.4% pre-operatively to 1.4 ± 0.6 and 21.7 ± 4.2% at final follow-up, respectively. There was no neurological worsening and radicular pain improved significantly compared with pre-operation in all the patients. Computed tomographic reconstruction 12 and 24 months after surgery showed bony fusion, normal position, and morphology of the fusion cage in all patients.
  
  
  CONCLUSIONS
  Mini-open retroperitoneal ALIF is an effective treatment for patients with recurrent lumbar disc herniation following primary posterior instrumentation.
  
  
  METHODS
  4.
authors.affiliation: Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China.
authors.forename: Maiwulanjiang
authors.initials: M
authors.lastname: Mamuti
authors.forename: Shunwu
authors.initials: S
authors.lastname: Fan
authors.forename: Junhui
authors.initials: J
authors.lastname: Liu
authors.forename: Zhi
authors.initials: Z
authors.lastname: Shan
authors.forename: Chongyan
authors.initials: C
authors.lastname: Wang
authors.forename: Shengyun
authors.initials: S
authors.lastname: Li
authors.forename: Fengdong
authors.initials: F
authors.lastname: Zhao
mesh_terms: D000328:Adult; D000368:Aged; D017586:Diskectomy; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012008:Recurrence; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome