A comparison of unilateral and bilateral pedicle screw fixation combined with transforaminal lumbar interbody fusion for lumbar degenerative diseases.

BACKGROUND: Bilateral transpedicular screw fixation in conjunction with interbody fusion is widely used to treat lumbar degenerative diseases; however, there are some disadvantages of using this fixation system. This study comparatively analyzes the results of unilateral and bilateral pedicle screw fixation combined with transforaminal lumbar interbody fusion (TLIF) for one-level lumbar degenerative diseases.

METHODS: Sixty-six cases with one-level lumbar degenerative diseases were studied. The patients were divided according to surgical approach into a unilateral group (Group A) and a bilateral group (Group B). The patients were evaluated for pain by visual analog scale (VAS) and Oswestry Disability Index (ODI). Operating time, blood loss, duration of hospitalization, and complication rate were also evaluated. Patients were examined at 1, 3, 6, and 12 months postoperatively and every year thereafter.

RESULTS: Group A patients' average preoperative VAS and ODI scores were 7.03 ± 0.98 and (64.22 ± 6.38)%, respectively, significantly decreased to 2.91 ± 0.88 and (14.42±2.08)%, respectively, at the last follow-up (P = 0.000). In Group B, the average preoperative VAS and ODI scores were 6.79 ± 0.86 and (63.22 ± 4.70)%, respectively, significantly decreased to 3.12 ± 0.96 and (14.62 ± 2.08)%, respectively, at the last follow-up (P = 0.000). No significant difference in the duration of hospitalization was found between groups. Operating time and blood loss of (125.9 ± 13.0) minutes and (211.4 ± 28.3) ml, respectively, in Group A were significantly less than (165.2 ± 15.3) minutes and (258.6 ± 18.3) ml, respectively, in Group B (P = 0.000). All patients achieved good bone union and had no pseudarthrosis at the last follow-up.

CONCLUSIONS: There are no clinical differences between unilateral and bilateral pedicle screw fixation combined with TLIF for one-level lumbar degenerative diseases. Unilateral fixation reduces operating time, bleeding, and cost of hospitalization.