Midline Minimally Open Interlaminar Lumbar Discectomy and Interspinous-Posterolateral Fusion as an Option to Treat Recurrent Lumbar Disc Herniations in Patients with Axial Instability

Abstract

Introduction

Numerous techniques have been used to treat lumbar recurrent disc herniations. Most of them offer an in site reintervention with or without treating the segmental instability. Currently, the “TLIF” technique stands as the premier option to treat both the symptoms and the instability.

Objective

We present our series of cases using the Midline Open Interlaminar Lumbar Discectomy and interspinous-posterolateral fusion technique as an option to treat recurrent disc herniations and flexion–extension instability. We design this prospective study.

Patients and Methods

A total of 19 patients (14 men and 5 women) with recurrent lumbar disc herniation who presented with axial pain and radiculopathy; ages 36 to 62 years (mean, 46 years) were included in the study. The affected levels were L4–L5 n11, L5–S1 n8, and L3–L4 n1; all the patients were monitored transoperatively and classified using ODI, VAS, and MacNabb clinical outcome measurements. We used the Lans-ASPEN interspinous device for the interspinous fixation and calcium phosphate as a graft. All our cases were transoperatively monitored using SEPs and EMG.

Results

Surgical time was 85 to 180 minutes (mean 120 minutes), EBL 20 to 300 mL (mean 50 mL), hospital stay 24 hours, pre-VAS (mean 8.16), first week (mean 2.67), 4 weeks (mean 1.11), 6 months (0.58), 1 year (0.76); ODI pre-op (mean 41.28), post-op 6 months (mean 18.1); MacNabb; excellent 47%, and good 52.6%.

Conclusion

The Midline Minimally Open Interlaminar Lumbar Discectomy and interspinous-posterolateral fusion it is a safe, reproducible, and resolute technique for patients with recurrent lumbar disc herniation and flexion–extension instability. We also recommend using neurophysiology surveillance on a regular basis to reduce the risk of complications and increase the clinical improvement rate. All the postoperative neurophysiology readings were positive in amplitude (mV) comparing with the pre-op registry. However, further normalization of the data are required to consider it clinically relevant.