Contralateral radiculopathy after transforaminal lumbar interbody fusion

Abstract

Transforaminal lumbar interbody fusion (TLIF) is an effective treatment for patients with degenerative spondylolisthesis and degenerative disc disease. Opposite side radiculopathy after the TLIF procedure has been recognized in this institution but has not been addressed in the literature. We present a case of opposite side radiculopathy after the TLIF procedure. We believe that this complication is related to asymptomatic stenosis on the contralateral side that is unmasked by the increased lordosis of the TLIF. The authors recommend increasing both disc height and foraminal height when choosing an interbody graft, and possibly decompressing the opposite foramen when preoperative MRI demonstrates foraminal stenosis.

Fig. 1

Preoperative X-rays demonstrate degenerative spondylolisthesis in a 65-year-old with right leg pain

Fig. 2

Preoperative mri demonstrates right L4–5 foraminal stenosis

Fig. 3

Preoperative MRI reveals asymptomatic left foraminal L4–5 stenosis

Fig. 4

Postoperative TLIF from the right side. The patient developed new onset left leg pain in L4 distribution

Fig. 5

The post operative CT scan revealed that the left pedicle screw was clearly outside the spinal canal and not responsible for the post operative leg pain

Fig. 6

The postoperative CT revealed stenosis in the left foramen

Fig. 7

Preoperative and postoperative CT scans after the TLIF procedure. The TLIF graft is not appreciated as the cut is at the level of the foramen. The CT scans are different in scale, but are measured with a computer imaging tool in order to give accurate measurements. Although the anterior disc space height has been increased from 6.5 to 8.0 mm, the posterior disc height has been decreased from 5.0 mm to 4.0 mm. The foraminal height has decreased due to the increased lordosis