Bilateral Pedicle Screw Fixation versus Unilateral Pedicle and Contralateral Facet Screws for Minimally Invasive Transforaminal Lumbar Interbody Fusion: Clinical Outcomes and Cost Analysis.
Study Design Retrospective clinical study. Objectives Recent biomechanical studies have shown no differences in stiffness or range of motion following minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) between unilateral pedicle and contralateral facet screw (UPFS) and bilateral pedicle screw (BPS) constructs. No studies have compared these two constructs based upon clinical outcomes. Methods Twenty-six consecutive patients who had single-level MIS TLIF were retrospectively reviewed. Outcome measures collected for patients with BPS were compared with those with UPFS. Results No associations were found between construct and length of stay (p = 0.5), operative time (p = 0.2), or Odom's criteria (p = 0.7); 79% of patients in the UPFS group as compared with 71.5% in the BPS group had good or excellent outcomes. Mean follow-up was 17.7 months for the UPFS group and 20.2 months for the BPS group. There was one complication in each group, including a seroma in the BPS group and a revision operation in the UPFS group. Implant costs for the BPS group were 35% greater than the UPFS group. Conclusions The present study is the first to demonstrate that patients undergoing MIS TLIF with BPS as compared with UPFS for single-level degenerative lumbar disease had similar clinical outcomes.
Department of Neurosciences, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States ; Department of Neurosurgery, Mansoura University School of Medicine, Mansoura, Egypt.
Basem I
BI
Awad
Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, United States.
Daniel
D
Lubelski
Department of Neurosurgery, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts, United States.
John H
JH
Shin
Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States.
Margaret A
MA
Carmody
Department of Neurosurgery, University of Florida, Gainesville, Florida, United States.
Daniel J
DJ
Hoh
Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, United States.
Thomas E
TE
Mroz
Department of Neurosciences, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States.
Michael P
MP
Steinmetz
Boucher facet screw; clinical outcomes; minimally invasive surgery; transforaminal lumbar interbody fusion