Abstract：Objective To compare the clinical results between transforaminal lumbar interbody fusion(TLIF) through Wiltse paraspinal approach and traditional posterior lumbar interbody fusion(PLIF)in treatment of recurrent lumbar disc herniation(RLDH).Methods A retrospective analysis was conducted of the 41 patients with RLDH who had lumbar interbody fusion from January 2009 to June 2014.Among them 17 cases received TLIF through Wiltse paraspinal approach(group TLIF)，and 24 cases received traditional PLIF(group PLIF).The patients in group PLIF had a tendency to have longer duration between initial discectomy and recurrent herniation.The two groups were compatible in preoperative clinical data(P＞0.05).The perioperative data(duration of procedure，intraoperative blood loss，postoperative drainage，time to ambulation，length of hospital stay) and primary efficacy outcome(visual analog scale for back and leg pain-VAS，Oswestry Disability IndexODI) were compared between 2 groups along with bony fusion(Criteria for interbody fusion assessment on post-operative computer tomography scans by Siepe et al) and complication.Results 41 patients were followed up for 24 to 60 months (mean，37.6 months).The operation time(115.6±24.5，110.0 min)，intraoperative blood loss(229.1±61.1，250 mL)，postoperative drainage(194.1±41.2，190.0 mL)，time to ambulation(3.1±0.7，3.0 days)，length of hospital stay(7.6±1.7，7.0 days) in group TLIF were significantly less than in group PLIF(P＜0.001).The postoperative VAS scores and ODI were significantly lower in 2 groups than the preoperative ones(P＜0.001)，but there was no significant difference between 2 groups at the12 months and 24 months follow up postoperatively(P＞0.05).6 cases had a dural tear in association with epidural fibrosis，1 case(4％) in group TLIF，5 cases(21％)in group PLIF，and these were treated by intra-operative repair.Cerebrospinal fluid leaks was found in2 cases in group PLIF postoperatively.1 patient from group PLIF suffered incisions fat colliquation.There was 3 cases of symptomatic adjacent segment disease in total，with 2 cases in group TLIF and 1 in group PLIF，expanded revision surgery was performed in thesepatients.Computer tomography scans revealed solid or complete interbody bony fusion at the last follow up in all cases.Conclusion TLIF through Wiltse paraspinal approach can achieve satisfactory clinical outcome in treatment of RLDH and it has several advantages including less invasive，lower incidence of complication such as intraoperative dural tear compared with traditional PLIF.
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