Abstract

Background: Young patients with lumbar disc herniation(LDH) tend to use minimally invasive techniques rather than early intervertebral fusion, but the high recurrence rate and the difficulty of thorough removal of osteophytes in the spinal canal become a thorny problem. For patients with high-risk recurrence of severe obesity and spinal canal stenosis, a modified posterior lumbar interbody fusion(MPLIF) procedure that includes insertion of a unilateral cage through the symptomatic side with supplementary bilateral pedicle screws has been conducted to reduce the recurrence rate and thoroughly remove calcified intervertebral discs(CID) and posterior vertebral margin osteoplasia (PVMO). Materials and methods: Three young patients with severe obesity and lumbar disc herniation, all with CID or PVMO, underwent a bilateral MPLIF using a single cage and bilateral pedicle screws. The postoperative clinical evaluation was based on visual analogue scale (VAS), Oswestry Disability Index (ODI) for back pain and leg pain, and Japanese Orthopaedic Association Scores (JOA) for neurological recovery at multiple time points following the surgery. Radiological assessments were performed with CT and MRI at 1-month after preoperation, and positive and lateral plain radiographs were taken at three days after operation, 1, 6 and 12 months postoperation and at the most recent follow-up. Results: Three patients all underwent a bilateral MPLIF using a single cage and bilateral pedicle screws and the mean duration for the surgeries was 101.67 min. The mean haemorrhage volume was 175 ml, and no blood transfusion was required for any of the cases. Twelve months postoperatively, all patients had achieved an Excellent or Good outcome (Excellent in 2 patients and Good in 1). None of the patients had recurrent disc herniation or fusion cage loss. The mean pain score was 7.33 prior to surgery and decreased to 2.00 at the 1-month postoperative examination.