Between 2009.9 and 2010.4, the transforaminal posterior lumbar interbody fusion (TLIF) was performed using the Tan metal interbody fusion device in 22 patients with postoperative recurrent lumbar disc herniation with posterior nail rod fixation, with good results, especially for the first time using Especially for the first time to use total laminectomy cases, it can significantly reduce the amount of bone required and has no significant effect on the fusion rate. 1. Clinical data 1.1 General data: 22 patients with recurrent lumbar disc herniation after surgery from 2009.9 to 2010.4, male: 8 cases, female: 14, age: 34-67 years old, average 62.3 years old, 1 case of lumbar 3/4 interval, 10 cases of lumbar 4/5 interval (including 2 cases of extreme lateral disc herniation), 5 cases of lumbar 5/sacral 1 interval, 5 cases of lumbar 4/5 combined with lumbar 5/sacral 1 interval There was one case of lumbar 3/4 lumbar 4/5 lumbar 5/sacral 1 triple hiatus. All patients in this group had a history of surgery, and the time of the first surgery ranged from 6 months to 20 years after admission. The main preoperative symptoms were radiating pain in the lower limbs of different degrees, recurrent lower back pain, intermittent claudication, soreness and swelling, and severe turning pain, inability to lie in bed for a long time, etc. On imaging, radiographs showed I°-II° slippage with slight narrowing of the intervertebral space, and power radiographs showed signs of instability in all slipped spaces. CT and MRI examinations suggested loss of intervertebral height, secondary spinal stenosis such as compression of the dural sac and nerve roots, synovial hyperplasia, synovial coalescence, etc., and absence or partial absence of the target segmental lamina. 1.2 Surgical operation: The patient is placed prone on an adjustable bowed surgical support under general anesthesia, the original surgical scar is located on the body surface, and the length of the surgical incision is marked according to the surgical site, and the skin is incised after disinfection and towel laying. The base of the transverse process is exposed, or the transverse process is partially exposed. The lateral edge of the articular eminence and the midpoint of the transverse process are opened, perforated and the integrity of the four walls of the pedicle is explored, the required pedicle screws are inserted, the required segments are fixed in sequence, and after fluoroscopic confirmation, the connecting rods are placed and propped open, and repositioning is given in cases requiring repositioning. On the patient’s symptomatic side, the bone knife removes the residual articular process or lamina (spare) and exposes the spinal canal along the intervertebral foramen. As the scar tissue remaining from the first surgical removal is adherent to the normal nerve roots or dura, gentle movements are made during the peeling to prevent tearing of the dura or injury to the nerve roots. The posterior longitudinal ligament, the fibrous ring, the herniated nucleus pulposus are removed, the cartilage endplates above and below the segment to be fused are processed, and the appropriate intervertebral fusion device is selected according to the size of the intervertebral space, and the model of the intervertebral fusion device is determined. If the bone is less to meet the fusion needs, above this stage can be part of the spinous process bone to supplement. Pre-testing of the intervertebral fusion device is required to avoid violent fusion of the endplate or fracture of the fusion device itself. The contralateral side should be decompressed together if symptomatic, flushed, checked for satisfactory nerve root freeing, and drains placed. Intradermal sutures are placed to close the incision. 1.3 Postoperative drain placement drainage 24-48 hours Remove the drainage tube according to the drainage and prophylactic antibiotics for 24-48 hours. Postoperatively, the relief of symptoms and neurological signs were closely observed; the patient could get up and move around with a lumbar brace 12 hours after surgery according to the patient’s wish, and started to do exercises for the lumbar back muscles 48 hours later. 1 week was discharged from the hospital, and bending movements were avoided and the lumbar brace was worn for 6 weeks after discharge. 1.4 The follow-up included: radiological examination: fusion, position of the nail plate and the presence of fracture, sinking of the intervertebral fusion, breakage of the end plate and displacement of the fusion, clinical assessment of low back pain and lower limb pain, and evaluation of postoperative efficacy using the Visual Analog Assessment Scale of Symptoms (VAS) and the SF-36 Health Survey Scale including health status, somatic function, and muscular pain [1]. 2, Results All patients in this group were successfully completed intraoperatively, and the operative time was 75-160 min ( mean 110 min) ; intraoperative bleeding was 300-800 mL ( mean 440 mL) ; there were 3 cases of intraoperative and postoperative complications of cerebrospinal fluid leakage, and there were no adverse sequelae after symptomatic treatment; there was 1 case of intraoperative fusion fracture; there were no cases of aggravation of nerve root symptoms, and all preoperative discomfort symptoms were significantly improved after surgery. The mean VAS score was 8.1 before surgery and 2.3 at 1 week after surgery. All 22 patients were followed up from 24 months to 31 months, with a mean of 27 months. All patients had no nail bar breakage, no sinking of the intervertebral fusion, and a mean of 4.6 months of postoperative radiographic follow-up for intervertebral implant fusion. At the follow-up after 8 weeks after surgery, the lumbar range of motion (including forward flexion, back extension, left and right lateral flexion, and left and right rotation) was significantly improved compared with that before surgery, and the patients were able to walk for a long time and resume normal life and work. After 4 months, the X-ray showed that the position was normal and the intervertebral implant was fused. 3. 3.1 Causes and treatment of postoperative recurrence of lumbar disc herniation After clinical symptoms appear and active conservative treatment is given, if the symptoms are not relieved or are not relieved significantly, the patient’s life and work should be treated surgically. The indications for surgery include: obvious neurogenic symptoms with motor and sensory dysfunction and ineffective non-surgical treatment; cauda equina nerve compression, i.e. with symptoms of anal and sphincter dysfunction; imaging suggestive of lumbar spinal canal, lateral saphenous fossa, nerve root canal stenosis or lumbar instability; and lumbar spinal canal stenosis caused by posterior edge of vertebral body hyperplasia, partial calcification of disc herniation or scar hyperplasia, etc. Dural sac Compression. The early surgical procedures for the treatment of this disease include total laminar decompression, hemi-laminar decompression, enlarged openings, openings for decompression and minimally invasive techniques such as discoscopic assisted nucleus pulposus removal, microscopic nucleus pulposus removal and radiofrequency ablation. Regardless of which technology is used, the main purpose of treatment is to remove the herniated disc tissue, so that the nerve roots are exposed to pressure and symptoms are eliminated or relieved. The patient’s symptoms are relieved and the discomfort is recovered to a certain extent. Due to the lack of understanding of spinal stability in the early stage, the posterior column of the spine is destroyed too much during surgery, and as the degeneration of the lumbar spine increases with the age of the patient, residual disc degeneration, hypertrophy of the articular processes, secondary stenosis of the spinal canal and consequently low back pain and lower limb symptoms occur, which seriously affect the life of the patient. There are many reasons for lumbar disc recurrence after lumbar disc herniation surgery, mainly related to the first surgical approach. Generally include: the degenerative nucleus pulposus tissue is not clear completely; normal nucleus pulposus tissue protrudes again after degenerative degeneration due to degeneration or long-term lumbar instability; loss of intervertebral height secondary to spinal stenosis after disc herniation surgery; more destruction of lumbar spine stability appears as a medical source of slippage of the lumbar spine; some minimally invasive surgery cannot completely remove the diseased tissue due to visual field, resulting in residual degenerative nucleus pulposus tissue; myelolytic enzymes or The ideal state was achieved within radiofrequency ablation; misdiagnosis of the extreme lateral disc and wrong segmental positioning, etc. In this group of patients, the initial surgery time in 2 cases was up to 20 years from the re-operation time. From the intraoperative situation, the surgery 20 years ago was mainly extensive exposure, total laminectomy and removal of most of the articular processes, a large number of scars in the spinal canal, serious nerve root adhesions, and serious damage to the stability of the lumbar spine. There were 5 patients who had no relief of symptoms after radiofrequency ablation and were found to have intact nucleus pulposus tissue compressing the nerve roots intraoperatively, and in 2 of them, the prolapsed nucleus pulposus tissue was located at the posterior edge of the vertebral body in front of the nerve roots. In 2 patients, the first preoperative imaging suggested a very lateral disc herniation, but the surgery did not clean up completely, and the herniated nucleus pulposus tissue was still found to be compressing the superior nerve root at that stage after removal of the affected articular eminence. 3.2 Postoperative recurrence of lumbar disc herniation Secondary recurrence treatment When the original symptoms of the patient reappear after lumbar disc herniation surgery and some patients are combined with low back pain and other symptoms, some patients can generally reduce the symptoms through conservative treatment, but some patients with poor conservative treatment require surgical intervention again, and scholars at home and abroad have certain controversies about the treatment of re-operation mainly focus on whether The main controversy is whether intervertebral fusion should be performed. Some scholars believe that after the first postoperative recurrence of symptoms, the patient’s spinal canal has been decompressed in the past, and simple nucleus pulposus removal is sufficient when conservative treatment is not effective, especially for patients with radiofrequency ablation or collagenase injection who do not need fusion fixation (except for patients with combined lumbar instability or lumbar spine slippage) [10]. However, most scholars support the need for fusion fixation in the second operation, mainly because: ① Although the first operation did not destroy the bony stable structure of the posterior lumbar column, the residual scar tissue after the operation leads to a restricted surgical field of view, and the inevitable expansion of the operation to expand the field of view causes the destruction of the posterior column structure, which may lead to lumbar instability and degeneration in the long term. ②After the first partial laminectomy, more bony structures may be removed in the second surgery, and the chance of postoperative complications of instability or slippage increases. In contrast, there is no controversy about fixation in patients with combined lumbar instability or slippage. (3) Re-operation clearly herniated disc or enlarged narrow spinal canal, the existence of scars seriously affects the operation, while access from the normal part can seriously reduce the damage of sclerotomal tear and nerve root, while removal of the articular eminence joint on one side can satisfy the need to enter the intervertebral space to clear the diseased nucleus pulposus tissue and decompress the spinal canal, thus avoiding nerve root and sclerotomal injury. In our group of 22 patients, the inferior articular process of the superior vertebral body and part of the superior articular process of the inferior vertebral body on the affected side of the vertebral space were removed under arch nail fixation, and the intervertebral space could be clearly revealed, and the location of the vertebral arch was entered and explored along the normal space, and the nerve roots were isolated along the medial wall of the arch, and the nerve roots were decompressed by searching for the site of compression, and the intervertebral space was treated and the intervertebral bone graft was fused and fixed through the articular process. There were no cases of nerve root injury, and only three patients had a small amount of cerebrospinal fluid leakage, and none of them had serious complications. The average VAS score of the patients before surgery was 8.1, which increased to 2.3 at 1 week after surgery, and the patients could basically take care of themselves in daily life after 1 week. 3.3 Advantages of using a tantalum intervertebral fusion Tantalum has multiple uses as a metallic element. Tantalum is highly ductile, ductile and resistant to corrosion, and does not react to hydrochloric acid, concentrated nitric acid or “aqua regia” under any conditions. Research has proven that tantalum not only does not cause any damage to the human body, but also allows human musculoskeletons to grow on it, which is medically known as bio-soluble. This property of tantalum is used to repair and close cracks and defects in broken skulls and fractured limbs. The intervertebral fusion device made of tantalum metal has a 5-mm microporous hole along which bone tissue grows, and its elastic modulus is basically similar to that of bone. It can save bone tissue from other parts of the body and avoid damage at the extraction site during interbody graft fusion especially in patients with total laminectomy. At the same time, it does not affect the effect of intervertebral implant fusion. All patients in this group used the frank metal interbody fusion device, which is simple to operate and can effectively reduce the amount of bone grafting. All patients had no nail rod breakage and no sinking of the interbody fusion device, and the average postoperative X-ray follow-up of interbody implant fusion was 4.6 months. However, it is necessary to fix the fusion device placement position and apply trial mold making during the drilling process, and place the violent implantation causing fusion device deformation and fragmentation. One case in this group was found to have fracture of the fusion device after surgery, which was not specially treated and was seen to be healing well on 4-month review, but should be avoided. In the postoperative recurrence of lumbar disc herniation using posterior transarticular approach frank metal intervertebral fusion device implant fusion effect is exact and less complications.