Transforaminal lumbar interbody fusion using unilateral pedicle screws and a translaminar screw

Abstract

Lumbar spinal fusion is advancing with minimally invasive techniques, bone graft alternatives, and new implants. This has resulted in significant reductions of operative time, duration of hospitalization, and higher success in fusion rates. However, costs have increased as many new technologies are expensive. This study was carried out to investigate the clinical outcomes and fusion rates of a low implant load construct of unilateral pedicle screws and a translaminar screw in transforaminal lumbar interbody fusion (TLIF) which reduced the cost of the posterior implants by almost 50%. Nineteen consecutive patients who underwent single level TLIF with this construct were included in the study. Sixteen patients had a TLIF allograft interbody spacer placed, while in three a polyetheretherketone (PEEK) cage was used. Follow-up ranged from 15 to 54 months with a mean of 32 months. A clinical and radiographic evaluation was carried out preoperatively and at multiple time points following surgery. An overall improvement in Oswestry scores and visual analogue scales for leg and back pain (VAS) was observed. Three patients underwent revision surgery due to recurrence of back pain. All patients showed radiographic evidence of fusion from 9 to 26 months (mean 19) following surgery. This study suggests that unilateral pedicle screws and a contralateral translaminar screw are a cheaper and viable option for single level lumbar fusion.

Comparison of minimally invasive versus open transforaminal lumbar interbody fusion in two-level degenerative lumbar disease

“…Lumbar fusion is a common surgical procedure for the treatment of symptomatic spinal pathologies, such as degenerative spinal disease, trauma, spondylolisthesis, and deformity [1,2]. Among various spinal fusion techniques, open transforaminal lumbar interbody fusion (TLIF) has been proven to be a safe technique to achieve lumbar fusion via a unilateral approach with minimal retraction of neural elements [3,4].…”

Increased incidence of pseudarthrosis after unilateral instrumented transforaminal lumbar interbody fusion in patients with lumbar spondylosis

“…2 Sethi et al reported that among a series of 19 patients, TLIF with unilateral pedicle screws supplemented by a contralateral translaminar facet screw resulted in excellent clinical outcomes and fusion rates. 28 In an attempt to improve on previously reported fusion rates without need for large iliac crest harvest, many authors began adding human bone morphogenetic protein (rhBMP-2) to the TLIF operation. 25 Although this usage is common, it is off-label.…”

A biomechanical comparison of 3 different posterior fixation techniques for 2-level lumbar spinal disorders

“…10,12,25 To preserve the reduced invasiveness of UPS fixation and overcome the shortcomings of insufficient strength, a hybrid fixation of UPS with a contralateral translaminar facet screw (UPSFS) has been applied in lumbar spinal surgeries. 15,23 To the best of our knowledge, several studies have evaluated the biomechanical performance of this hybrid instrumentation technique.15,23-25 However, most researchers only focused on single-level conditions, and the biomechanics of this hybrid technique at 2 levels have not been well characterized.abbreviatioNS BPS = bilateral pedicle screw; NZ = neutral zone; ROM = range of motion; TLFS = translaminar facet screw; UPS = unilateral pedicle screw; UPSFS = UPS with contralateral translaminar facet screw. Submitted January 9, 2015. obJect This study sought to make a biomechanical comparison of 3 different posterior fixation techniques for 2-level lumbar spinal disorders.…”

“…10,12,25 To preserve the reduced invasiveness of UPS fixation and overcome the shortcomings of insufficient strength, a hybrid fixation of UPS with a contralateral translaminar facet screw (UPSFS) has been applied in lumbar spinal surgeries. 15,23 To the best of our knowledge, several studies have evaluated the biomechanical performance of this hybrid instrumentation technique. 15,[23][24][25] However, most researchers only focused on single-level conditions, and the biomechanics of this hybrid technique at 2 levels have not been well characterized.…”

“…15,23 To the best of our knowledge, several studies have evaluated the biomechanical performance of this hybrid instrumentation technique. 15,[23][24][25] However, most researchers only focused on single-level conditions, and the biomechanics of this hybrid technique at 2 levels have not been well characterized.…”