title: Unilateral versus bilateral pedicle screw instrumentation for single-level minimally invasive transforaminal lumbar interbody fusion.
abstract: Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has become an increasingly popular method of lumbar arthrodesis. However, there are few published studies comparing the clinical outcomes between unilateral and bilateral instrumented MIS TLIF. Sixty-five patients with degenerative lumbar spine disease were enrolled in this study. Thirty-one patients were randomized to the unilateral group and 34 to the bilateral group. Recorded demographic data included sex, age, preoperative diagnosis, and degenerated segment. Operative time, blood loss, hospital stay length, complication rates, and fusion rates were also evaluated. The Oswestry Disability Index (ODI) score and Visual Analog Scale (VAS) pain score data were obtained. All patients were asked to follow-up at 3 and 6 months after surgery, and once every 6 months thereafter. The mean follow-up was 26.6 months (range 18-36 months). The two groups were similar in sex, age, preoperative diagnosis, and operated level. The unilateral group had significantly shorter operative time, lower blood loss, and shorter hospital time than the bilateral group. The average postoperative ODI and VAS scores improved significantly in each group. No significant differences were found between the two groups in relation to ODI and VAS. All patients showed evidence of fusion at 12 months postoperatively. The total fusion rate, screw failure, and general complication rate were not significantly different. Results showed that single-level MIS TLIF with unilateral pedicle screw fixation would be sufficient in the management of preoperatively stable patients with lumbar degenerative disease. It seems that MIS TLIF with unilateral pedicle screw instrumentation is a better choice for single-level degenerative lumbar spine disease.
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai 200072, China.
authors.forename: Xiaolong
authors.initials: X
authors.lastname: Shen
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai 200072, China.
authors.forename: Hailong
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai 200072, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Gu
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai 200072, China.
authors.forename: Guangfei
authors.initials: G
authors.lastname: Gu
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai 200072, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai 200072, China. Electronic address: spine_shen@163.com.
authors.forename: Shisheng
authors.initials: S
authors.lastname: He
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D010147:Pain Measurement; D065289:Pedicle Screws / Q000009:adverse effects; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Minimally invasive; Spinal fusion; TLIF; Unilateral pedicle screw fixation