Unilateral versus Bilateral Pedicle Screw Instrumented Transforaminal Interbody Fusion in a Single Level Lumbar Spondylolisthesis

Mohamed Mohi Eldin; Ahmed Salah Aldin Hassan; Mohamed Alaa Eldin Thabet; Mohamed I. Refaat; Ali Y. Elkady; Mohamed Baraka

doi:10.3889/oamjms.2022.8969

Authors

Mohamed Mohi Eldin Department of Neurosurgery
Ahmed Salah Aldin Hassan Department of Neurosurgery, Faculty of Medicine, Cairo University, Giza, Egypt
Mohamed Alaa Eldin Thabet Department of Neurosurgery, Faculty of Medicine, Cairo University, Giza, Egypt
Mohamed I. Refaat Department of Neurosurgery, Faculty of Medicine, Cairo University, Giza, Egypt
Ali Y. Elkady Department of Neurosurgery, Faculty of Medicine, Cairo University, Giza, Egypt https://orcid.org/0000-0002-3197-8672
Mohamed Baraka Department of Neurosurgery, Faculty of Medicine, Cairo University, Giza, Egypt

DOI:

https://doi.org/10.3889/oamjms.2022.8969

Keywords:

Single level spondylolisthesis, Unilateral screws, Bilateral screws, Transforaminal lumbar interbody fusion, Developing countries

Abstract

Background

The study aims to assess the efficiency, safety and outcome of unilateral pedicle screw fixation with TLIF (Transforaminal lumbar interbody fusion) vs bilateral pedicle screw fixation with TLIF in cases of single level spondylolisthesis by comparing clinical, functional outcome and the complication rates.

Methods

We prospectively collected demographics and clinical data of the patients with surgically treated single level lumbar spondylolisthesis grade 1 (n=60) with follow up and comparison between clinical/functional outcomes and complication rates between January 2020 and January 2021 at Cairo University hospitals. We allocated the patients with the unilateral pedicle screw fixation with TLIF as group A and the patients with the bilateral pedicle screw fixation with TLIF as group B.

Results

Clinical outcome showed statistical significance between Group A and Group B (P-value < 0.001); Functional outcome (using Oswestry’s disability index) between group A and B also showed statistical significance (P-value < 0.001) in favor of group B. Complications in group A was higher especially cage migration in 26.7% of cases with p-value of 0.026 while it was only present in 3.3% of the group B cases.

Conclusion

We concluded that the bilateral approach showed a statistically significant better clinically/functional outcomes with lower rates of complication in comparison with the unilateral approach.

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References

Xiao YX, Chen QX, Li FC. Unilateral transforaminal lumbar interbody fusion: A review of the technique, indications and graft materials. J Int Med Res. 2009;37(3):908-17. https://doi.org/10.1177/147323000903700337 PMid:19589277

Wang SJ, Han YC, Liu XM, Ma B, Zhao WD, Wu DS, et al. Fusion techniques for adult isthmic spondylolisthesis: A systematic review. Arch Orthop Trauma Surg. 2014;134(6):777-84.

Ambati DV, Wright EK Jr., Lehman RA Jr., Kang DG, Wagner SC, Dmitriev AE. Bilateral pedicle screw fixation provides superior biomechanical stability in transforaminal lumbar interbody fusion: A finite element study. Spine J. 2015;15(8):1812-22. https://doi.org/10.1016/j.spinee.2014.06.015 PMid:24983669

Lin B, Lin QY, He MC, Liu H, Guo ZM, Lin KS. Clinical study on unilateral pedicle screw fixation and interbody fusion for the treatment of lumbar degenerative diseases under Quadrant system. Zhongguo Gu Shang. 2012;25(6):468. PMid:23016381

Chan YH. Biostatistics 103: Qualitative data-tests of independence. Singapore Med J. 2003;44(10):498-503. PMid:15024452

Gologorsky Y, Skovrlj B, Steinberger J, Moore M, Arginteanu M, Moore F, et al. Increased incidence of pseudarthrosis after unilateral instrumented transforaminal lumbar interbody fusion in patients with lumbar spondylosis. J Neurosurg Spine. 2014;21(4):601-7. https://doi.org/10.3171/2014.6.SPINE13488 PMid:25084031

Ren C, Qin R, Sun P, Wang P. Effectiveness and safety of unilateral pedicle screw fixation in transforaminal lumbar interbody fusion (TLIF): A systematic review and meta-analysis. Arch Orthop Trauma Surg. 2017;137(4):441-50. https://doi.org/10.1007/s00402-017-2641-y PMid:28168642

Duncan JW, Bailey RA. An analysis of fusion cage migration in unilateral and bilateral fixation with transforaminal lumbar interbody fusion. Eur Spine J. 2013;22(2):439-45. https://doi.org/10.1007/s00586-012-2458-x PMid:22878377

Liu F, Feng Z, Zhou X, Liang Y, Jiang C, Li X, et al. Unilateral versus bilateral pedicle screw fixation in transforaminal lumbar interbody fusion. Clin Spine Surg. 2017;30(6):E776-83.

Liang Y, Shi W, Jiang C, Chen Z, Liu F, Feng Z, et al. Clinical outcomes and sagittal alignment of single-level unilateral instrumented transforaminal lumbar interbody fusion with a 4 to 5-year follow-up. Eur Spine J. 2015;24(11):2560-6. https://doi.org/10.1007/s00586-015-3933-y PMid:25870077

Shen X, Zhang H, Gu X, Gu G, Zhou X, He S. Unilateral versus bilateral pedicle screw instrumentation for single-level minimally invasive transforaminal lumbar interbody fusion. J Clin Neurosci. 2014;21(9):1612-6. https://doi.org/10.1016/j.jocn.2013.11.055 PMid:24814852

Xue H, Tu Y, Cai M. Comparison of unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in degenerative lumbar diseases. Spine J. 2012;12(3):209-15. https://doi.org/10.1016/j.spinee.2012.01.010 PMid:22381573

Dahdaleh NS, Nixon AT, Lawton CD, Wong AP, Smith ZA, Fessler RG. Outcome following unilateral versus bilateral instrumentation in patients undergoing minimally invasive transforaminal lumbar interbody fusion: A single-center randomized prospective study. Neurosurg Focus. 2013;35(2):E13. https://doi.org/10.3171/2013.5.FOCUS13171 PMid:23905951