Mini-open transforaminal lumbar interbody fusion through a modified Wiltse paraspinal approach for recurrent lumbar disc herniation

Recurrent lumbar disc herniation (RLDH) has been estimated to occur in 5% to 15% of patients after discectomies. Traditional transforaminal lumbar interbody fusion (TLIF) is characterized by great trauma. In recent years, surgical treatment of lumbar degenerative diseases has shown a minimally-invasive trend, with the TLIF technique developing to mini-open incisions. Perioperative data (duration of procedure, intraoperative blood loss, postoperative drainage, time to ambulation, length of hospital stay) and primary efficacy outcomes (visual analog scale for back and leg pain-VAS and Oswestry Disability Index-ODI) were compared between the mini-open TLIF group and TLIF group, along with bony fusion and complications. A total of 45 patients were followed up for 24 to 60 months. VAS scores and ODIs were significantly reduced in the 2 groups after surgery (P<0.001). Operation time, intraoperative blood loss, postoperative drainage, time to ambulation and length of hospital stay significantly decreased in the TLIF group, compared with the PLIF group (P<0.001). Mini-open TLIF through a modified Wiltse paraspinal approach can achieve satisfactory clinical outcomes in the treatment of RLDH. It has several advantages, including less invasiveness and lower incidence of complications, such as intraoperative dural tears, compared with traditional TLIF.