Bilateral transformational thoracolumbar interbody fusion for the treatment of giant central thoracolumbar junction disc herniation: A prospective clinical and radiological study.

STUDY DESIGN: Clinical and radiological assessment of prospective single-center data.

BACKGROUND: The optimal treatment strategy for giant central thoracolumbar junction disc herniation (TLDH) remains controversial.

OBJECTIVE: This study aimed to report the clinical and radiological results of bilateral transformational thoracolumbar interbody fusion (bilateral TTIF) to treat giant central TLDH.

METHODS: Seventeen consecutive patients with giant central TLDH underwent bilateral TTIF from January 2014 to June 2014 and were followed for 9-15 months. Clinical and radiological data were prospectively examined, including operative time, blood loss, pre- and postoperative American Spinal Injury Association (ASIA) score for sensory and motor function, visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, fusion rate, extent of decompression, rate of instrumentation failure, and complications.

RESULTS: The average time of surgery was 160 ± 37 min, and blood loss was 884 ± 197 ml. The ASIA sensory and motor scores improved from 72.76 ± 3.36 to 90.71 ± 2.54 and from 68.47 ± 4.7 to 88.0 ± 3.2, respectively. VAS for back pain and ODI decreased from 6.65 ± 1.93 to 2.23 ± 0.56 and from 42.82 ± 5.08 to 11.3 ± 2.3, respectively. Canal encroachment improved from 50.3 ± 6.6% to 2 ± 0.3% at the last follow-up. Surgery complications were seen in 5 patients (29%), who experienced intraoperative dural tear and cerebrospinal fluid leak. There were no other major complications at the last follow-up.

CONCLUSIONS: Bilateral TTIF produced satisfactory outcomes and may be one of the surgical treatments of choice for myelopathy due to giant central TLDH.