Comparative Analysis of Unilateral versus Bilateral Instrumentation in TLIF for Lumbar Degenerative Disorder: Single Center Large Series

Abstract

Background: Transforaminal lumbar interbody fusion (TLIF) with bilateral pedicle screw instrumentation is a well-accepted technique in lumbar degenerative disc disorder. Unilateral instrumentation in TLIF has been reported in the literature. This study aims to compare the clinical and radiological outcomes of unilateral and bilateral instrumented TLIF in a selected series of patients.Methods: We retrospectively analyzed patients operated with unilateral pedicle screw fixation in TLIF (UPSF TLIF) or with bilateral pedicle screw fixation in TLIF (BPSF TLIF) with a minimum of 2 years of follow-up. Patients were evaluated at regular intervals for functional and radiological outcomes. Functional outcome was assessed using the Oswestry disability index (ODI) and visual analog score (VAS) preoperatively and at 6 months, 1 year, and 2 years after surgery. Fusion rates were assessed using Bridwell interbody fusion grading.Results: Our study shows that there was a significant improvement in VAS and ODI in both groups at 2 years follow-up, and there was no significant difference in improvements between the groups. The complication rates between the groups were similar. The fusion rate in UPSF TLIF was 97.3% and was 98.34% in BPSF TLIF; this was not statistically significant between groups. There is a significant difference in terms of blood loss, duration of surgery, and average duration of hospital stay between the groups (P , .001), favoring UPSF TLIF.Conclusions: Unilateral pedicle screw fixation in open TLIF is comparable with bilateral pedicle screw fixation in terms of patient-reported clinical outcomes, fusion rates, and complication rates with the additional benefits of less operative time, less blood loss, shorter hospitalization, and less cost in selective cases.

Safety and efficacy of unilateral and bilateral pedicle screw fixation for lumbar degenerative diseases by transforaminal lumbar interbody fusion: An updated systematic review and meta-analysis

“…Complications rate was evaluated in 5 studies including 465 patients ( 20 , 22 , 24 , 28 , 30 ). The results of the fixed-effect model meta-analysis showed that: there was no statistical significance in the overall difference between UPSF and BPSF [RR = 0.94, 95% CI (0.9154–1.63), P = 0.82; Figure 10 ].…”

Biomechanical Comparison of Unilateral and Bilateral Pedicle Screw Fixation after Multilevel Lumbar Lateral Interbody Fusion

“…Unilateral, as opposed to bilateral, pedicle screw and rod instrumentation as supplemental posterior fixation has important advantages including decreased blood loss, decreased operating room time, and short-term improvement in postoperative pain. [23][24][25][26] Multiple large series of patients undergoing TLIF have reported lower cost and equivalent clinical outcomes with unilateral screw and rod fixation, although rates of non-union and cage migration may be higher. [24][25][26] The use of unilateral pedicle screw fixation for LLIF has been described with good clinical and radiographic results.…”

“…23-26 Multiple large series of patients undergoing TLIF have reported lower cost and equivalent clinical outcomes with unilateral screw and rod fixation, although rates of non-union and cage migration may be higher. 24-26…”

“…[23][24][25][26] Multiple large series of patients undergoing TLIF have reported lower cost and equivalent clinical outcomes with unilateral screw and rod fixation, although rates of non-union and cage migration may be higher. [24][25][26] The use of unilateral pedicle screw fixation for LLIF has been described with good clinical and radiographic results. Wen et al retrospectively compared 74 patients undergoing single-level LLIF supplemented with either unilateral or bilateral screw fixation and reported significantly decreased medical expenses ($11,044.80 vs $15,018.40) and lower Oswestry Disability Index (ODI) and visual analog pains scores (VAS) at 7-days postoperatively in the unilateral fixation group.…”

MRI Assessment of the Early Disc Degeneration Two Levels above Fused Lumbar Spine Segment: A Comparison after Unilateral and Bilateral Transforaminal Lumbar Interbody Fusion (TLIF) Procedure

“…Additionally, the stiffness that follows BPSF may play a role in increasing stress at intervertebral segments that lie adjacent to the fused segment. This could be, among other factors, another reason for adjacent segment pathology [ 5 , 6 ]. Adjacent segment degeneration (ASD) may potentially occur as a long-term complication after undergoing a spinal fusion surgery [ 7 ].…”