Unilateral versus bilateral percutaneous pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Clinical results for unilateral pedicle screw fixation after lumbar interbody fusion have been reported to be as good as those for bilateral instrumentation. However, no studies have directly compared unilateral and bilateral percutaneous pedicle screw fixation after minimally invasive surgery (MIS) for transforaminal lumbar interbody fusion (TLIF). The purpose of this study was to determine whether unilateral percutaneous pedicle screw fixation is comparable with bilateral percutaneous pedicle screw fixation in 1-segment MIS TLIF.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This was a prospective randomized study of 53 patients who underwent unilateral or bilateral percutaneous pedicle screw fixation after MIS TLIF for 1-segment lumbar degenerative disc disease. Twenty-six patients were assigned to a unilateral percutaneous pedicle screw fixation group and 27 patients were assigned to a bilateral percutaneous pedicle screw fixation group. Operative time, blood loss, clinical outcomes (that is, Oswestry Disability Index [ODI] and visual analog scale [VAS] scores), complication rates, and fusion rates were assessed using CT scanning 2 years after surgical treatment.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The 2 groups were similar in age, sex, preoperative diagnosis, and operated level, and they did not differ significantly in the length of follow-up (27.5 [Group 1] vs 28.9 [Group 2] months) or clinical results. Both groups showed substantial improvements in VAS and ODI scores 2 years after surgical treatment. The groups differed significantly in operative time (unilateral 84.2 minutes; bilateral 137.6 minutes), blood loss (unilateral 92.7 ml; bilateral, 232.0 ml), fusion rate (unilateral 84.6%; bilateral 96.3%), and postoperative scoliotic change (unilateral 23.1%; bilateral 3.7%).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Unilateral and bilateral screw fixation after MIS TLIF produced similar clinical results. Although perioperative results were better with unilateral screw fixation, the long-term results were better with bilateral screw fixation, suggesting bilateral screw fixation is a better choice after MIS TLIF.</jats:p></jats:sec>

Unilateral versus Bilateral Instrumentation in Spinal Surgery: A Systematic Review

“…Five studies compared unilateral with bilateral instrumentation using open transforaminal or posterior lumbar interbody fusion (TLIF/PLIF),6 7 8 9 10 one study used open posterolateral fusion,3 and four used minimally invasive TLIF/PLIF11 12 13 14 (Table 1). …”

Minimally Invasive Transforaminal Lumbar Interbody Fusion with Unilateral Pedicle Screw Fixation: Comparison between Primary and Revision Surgery

“…Bilateral pedicle screw fixation after MIS TLIF is generally accepted as a standard procedure for symptomatic spinal pathology treatment, [7–9] but many clinical trials have reported positive outcomes (short operation time, less blood loss, and short hospital stay) associated with unilateral pedicle screw fixation after conventional TLIF and MIS TLIF [10–12]. Although previous reports showed that unilateral pedicle screw fixation after MIS TLIF is comparable to bilateral screw fixation, we already reported that less fusion rate (unilateral 84.6%; bilateral 96.3%) and more postoperative scoliosis change rate (unilateral 23.1%; bilateral 3.7%) with unilateral screw fixation than bilateral screw fixation after MIS TLIF [20]. The authors reported in a previous study that numerous degenerative disc diseases are associated with instability, which supports the report that bilateral screw fixation has better outcomes than unilateral screw fixation [20].…”

“…MIS TLIF itself needs time to overcome learning curve, and from previous studies, we already know that it needs more than 20 cases experience in MIS TLIF to overcome learning curve [26, 28]. The authors started MIS TLIF from 2008 and previous results of MIS TLIF as primary surgery by us were already reported [6, 20] and experienced more than 100 cases MIS TLIF before starting this study, so we are sure that learning curve did not make any problems at this study.…”

Realizable Minimally Invasive 1-Day Lumbar Interbody Fusion Surgery: No General Anesthesia, No Hemovac Insertion, No Skin Suture Surgery, and Early Ambulation

“…The retractor was angled medially, The patient was tilted laterally to decompress the contralateral side. Extensive decompression was performed, which included decompression of the central stenosis and contralateral side 1,6,9) . A discectomy was also performed.…”