Comparative Study of Posterior Lumbar Interbody Fusion via Unilateral and Bilateral Approaches in Patients with Unilateral Leg Symptoms

Abstract

Unilateral laminectomy can minimize the operative time and perioperative blood loss in PLIF procedure. However, the different preoperative disc height between two groups is a limitation of this study. Despite this limitation, solid fusion and satisfactory symptomatic improvement could be achieved uniquely by our surgical method. This surgical method can be an alternative surgical technique in patients with unilateral leg pain.

Clinical and Radiological Results of Microsurgical Posterior Lumbar Interbody Fusion and Decompression without Posterior Instrumentation for Lateral Recess Stenosis

“…Various surgical procedures have been used to surgically treat LRS: lumbar spinal fusions, such as posterolateral fusion, PLIF, translumbar interbody fusion, anterior lumbar interbody fusion, and decompressive surgery (including laminectomy and facetectomy. Traditional, open decompressive surgery and posterolateral fusion with additional posterior instrumentation have been widely used for LRS, but may cause musculoligamentous injuries [ 12 20 ]. Without accompanying posterior instrumentation, a posterolateral fusion cannot maintain the disc height and cannot contribute to the fusion [ 8 9 12 21 ].…”

“…PLIF has been widely used as a surgical technique for spinal diseases, including spinal stenosis and degenerative disc disease. However, this technique, using an interbody cage without posterior stabilization, may lead to instability if a wide laminectomy and facetectomy are performed [ 12 22 ]. PLIF can also successfully restore disc height and anterior column alignment, as well as stabilize the disc space.…”

“…PLIF can also successfully restore disc height and anterior column alignment, as well as stabilize the disc space. Thus, the technique has the advantages of high fusion rates that lead to early stabilization, with the additional use of a pedicle screw fixation [ 12 17 21 23 ]. Posterior instrumentation, following PLIF, can hinder iatrogenic instability and may cause musculoligamentous injuries [ 12 24 ].…”

“…PLIF, used to treat several spinal diseases, was first described by Cloward [ 11 ] in 1953. Open PLIF, involving the use of an interbody cage and posterior pedicle screw instrumentation, has been widely used for restoring disc height, decompressing the spinal nerve roots and dural sac, and segmental alignment during the treatment of LRS [ 12 13 14 ]. Tissue denervation and ischemia, associated with the traditional posterior approach, have been reported by many authors and cause continued postoperative symptoms [ 15 16 ] PLIF, without posterior pedicle fixation to reduce these complications, can cause cage migration and iatrogenic instability [ 12 17 ].…”

Introducing a New Risk Factor for Lumbar Disc Herniation in Females : Vertical Angle of the Sacral Curvature

“…Today, lumbar spinal fusion surgery has been commonly performed for patients who present with chronic back pain with neurological symptoms23). At present, neurosurgical practice is confronted by an explosion of technology10,11).…”