A prospective clinical study comparing MI-TLIF with unilateral versus bilateral transpedicular fixation in low grade lumbar spondylolisthesis

Abstract

Background: Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has become one of the standard techniques for approaching ipsilateral decompression, anterior column fusion, and posterior stabilization. This procedure is usually accompanied by the placement of bilateral transpedicular screws in the corresponding segment. The purpose of this study was to evaluate the clinical efficacy of unilateral screw fixation compared with bilateral fixation in patients diagnosed with low-grade symptomatic lumbar spondylolisthesis who underwent an MI-TLIF technique.Methods: A prospective and comparative study was performed in 67 patients with grade 1 symptomatic lumbar spondylolisthesis. The sample was allocated on both unilateral fixation group (n=33) and bilateral fixation group (n=34). Clinical outcomes were evaluated using Oswestry Disability Index (ODI), visual analogue scale (VAS) for leg and back pain, and Short Form 36 Health Survey (SF-36), preoperatively, and at 1, 3, 6, and 12 months postoperatively. Changes over time and differences between the groups were analyzed. Statistical analyses included: Friedman test, Student's t-test and Mann-Whitney's U. A two-tailed P value of <0.05 was considered significant.Results: During 1-year of evaluation there were no significant clinical differences between both groups.Conclusions: Patients with grade 1 symptomatic lumbar spondylolisthesis treated with MI-TLIF with unilateral screw fixation had similar clinical results than those treated with bilateral fixation at 12 months postoperatively.

Clinical results after surgical treatment in young male patients with low grade isthmic spondylolisthesis

“…They compared the two groups using VAS and ODI scales. They reported that there was no clinical difference between the two groups in the 1-year follow-up results [17]. Kabins et al reported TLIF + spinal instrumentation results with unilateral (16 patients) and bilateral (20 patients) approach were satisfactory in 36 patients with isolated Lumbar 4-5 isthmic spondylolisthesis; but there was no clinical difference between the 2 surgical methods [18].…”

“…It is reported that transforaminal lumbar interbody fusion (TLIF) is the ideal test for ipsilateral decompression and this technique allows for ipsilateral decompression, anterior fusion, and posterior stabilization [17]. Soriano-Sánchez et al reported that all patients were stabilized by minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in 33 patients unilaterally and in 34 patients by bilateral transpedicular fixation as a surgical treatment in their study of 67 patients with lumbar spondylolisthesis.…”

Comparison of minimally invasive and open transforaminal lumbar interbody fusion in the treatment of single segmental lumbar spondylolisthesis: minimum two-year follow up

“…The indications of MI-TLIF in treatment of lumbar spondylolisthesis were still uncertain, in our study, only Meyerding grade I or II patients were included. Quraishi and Rampersaud reported (31) that used bilateral MI-TLIF in the treatment of Meyerding grade III spondylolisthesis, and suggested that it can correct focal deformity, achieve excellent radiographic and clinical outcomes, which was similar to the open TLIF, however, most surgeons use the MI-TLIF in treatment of lower grade lumbar spondylolisthesis currently (19), still without lager case series and compared study about MI-TLIF in treatment of high grade lumbar spondylolisthesis.…”

“…Minimally invasive TLIF (MI-TLIF) was aided with the tubule and endoscopy to decompression and interbody fusion (15,16), was reported had advantages of less blood loss, quicker recovery and lower wound infection (17). Although there were some short-term follow-up literature report about using MI-TLIF in treatment of lumbar spondylolisthesis (18)(19)(20)(21), it still questioned by its limited operative view and space (22,23), hard learning curve (24) and may higher incidence of hardware-related complications (25).…”

Multilevel Unilateral Pedicular Screw Fixation with Interbody Fusion in Surgery of Double- and Triple-Segment Lumbar Disc Pathology

“…17 Other studies 15,10 found that unilateral fixation harbored poorer biomechanical criteria, whereas, theoretically, unilateral fixation offers much shorter operative time, less bleeding, and less costs. 7,16 Therefore, unilateral fixation is considered spine surgery's grey zone and its efficacy is still not fully understood. 5 The evaluation of the technique should be judged by revising the spectrum of clinical and radiological differences pre-and postoperatively.…”