J Korean Neurosurg Soc.  2015 Oct;58(4):350-356. 10.3340/jkns.2015.58.4.350.

Acute Contralateral Radiculopathy after Unilateral Transforaminal Lumbar Interbody Fusion

• Jang KM
• Park SW
• Kim YB
• Park YS
• Nam TK
• Lee YS

• KMID: 2114372
• DOI: http://doi.org/10.3340/jkns.2015.58.4.350

Abstract

OBJECTIVE
Cases of contralateral radiculopathy after a transforaminal lumbar interbody fusion with a single cage (unilateral TLIF) had been reported, but the phenomenon has not been explained satisfactorily. The purpose of this study was to determine its incidence, causes, and risk factors.
METHODS
We did retrospective study with 546 patients who underwent a unilateral TLIF, and used CT and MRI to study the causes of contralateral radicular symptoms that appeared within a week postoperatively. Clinical and radiological results were compared by dividing the patients into the symptomatic group and asymptomatic group.
RESULTS
Contralateral symptoms occurred in 32 (5.9%) of the patients underwent unilateral TLIF. The most common cause of contralateral symptoms was a contralateral foraminal stenosis in 22 (68.8%), screw malposition in 4 (12.5%), newly developed herniated nucleus pulposus in 3 (9.3%), hematoma in 1 (3.1%), and unknown origin in 2 patients (6.3%). 16 (50.0%) of the 32 patients received revision surgery. There was no difference in visual analogue scale and Oswestry disability index between the two groups at discharge. Both preoperative and postoperative contralateral foraminal areas were significantly smaller, and postoperative segmental angle was significantly greater in the symptomatic group comparing to those of the asymptomatic group (p<0.05).
CONCLUSION
The incidence rate is not likely to be small (5.9%). If unilateral TLIF is performed for cases when preoperative contralateral foraminal stenosis already exists or when a large restoration of segmental lordosis is required, the probability of developing contralateral radiculopathy is increased and caution from the surgeon is needed.

Keyword

Spinal stenosis; Complication; Radiculopathy; Lumbar manipulation; Lordosis

MeSH Terms

Animals
Constriction, Pathologic
Hematoma
Humans
Incidence
Lordosis
Magnetic Resonance Imaging
Manipulation, Spinal
Radiculopathy*
Retrospective Studies
Risk Factors
Spinal Stenosis

Figure

• 

  Fig. 1 Measurement of lumbar lordosis, segmental angle, disc height and contralateral foraminal area. A : Lumbar lordosis : the angle between L1 and S1 upper endplates. B : Segmental angle : the angle between the upper and lower endplates at the disc space where surgery was done. C : Disc height: the distance between the upper and lower endplates at the center of the disc space at the surgical site from the sagittal view in the plain radiograph. Foraminal area : the area of bony neural foramen.

• 

  Fig. 2 Cases of contralateral radiculopathy after unilateral TLIF. A : Contralateral foraminal stenosis after surgery, showing superior and ventral subluxation of the superior articular process of inferior vertebra. B : Contralateral screw malposition. C : Newly developed HNP at the contralateral side. D : Epidural hematoma. TLIF : transforaminal lumbar interbody fusion, HNP : herniated nucleus pulposus.

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