title: 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.
authors.affiliation: Department of Orthopedics, Henry Ford Health System, Detroit, MI, USA. drsethi11@rediffmail.com
authors.forename: Anil
authors.initials: A
authors.lastname: Sethi
authors.forename: Sandra
authors.initials: S
authors.lastname: Lee
authors.forename: Rahul
authors.initials: R
authors.lastname: Vaidya
mesh_terms: D000328:Adult; D000368:Aged; D001577:Benzophenones; D001863:Bone Screws / Q000592:standards*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007659:Ketones / Q000627:therapeutic use; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011108:Polymers; D019736:Prostheses and Implants / Q000706:statistics & numerical data; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous / Q000379:methods / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D001577:Benzophenones; D007659:Ketones; D011108:Polymers; C063834:polyetheretherketone; D011092:Polyethylene Glycols