title: Comparison of three different posterior fixation techniques in transforaminal lumbar interbody fusion for two-level lumbar degenerative diseases: At a mean follow up time of 46 months.
abstract: OBJECTIVE
  This study sought to retrospectively compare three different posterior fixation techniques in transforaminal lumbar interbody fusion for two-level lumbar degenerative diseases.
  
  
  METHODS
  This was a retrospective single-center study including 84 patients who underwent TLIF instrumented with unilateral pedicle screws (UPS), unilateral pedicle screws plus contra-lateral translaminar facet screws (UPSFS), or bilateral pedicle screws (BPS) between June 2008 and May 2012. These patients were divided into three groups: UPS (n=22), UPSFS (n=28) and BPS (n=34) group. Operative time, blood loss, length of hospital stay, hospital bill, fusion status and complications were recorded and analyzed statistically. Visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association Scores (JOA) were used to assess the preoperative and postoperative pain and functional outcome. Sagittal alignment was evaluated by the segment lordosis (SL) and whole lumbar spine lordosis (LL).
  
  
  RESULTS
  The mean follow up duration was 46.2 (ranging from 36 to 60) months. A significant decrease occurred in operative time, blood loss and hospital bill in UPS and UPSFS group, compared with BPS group (p<0.05). The average postoperative VAS, ODI and JOA scores improved significantly in each group than the preoperative counterparts (p<0.05), however, there were no significant difference between groups at any follow-up time point (p>0.05). No statistically difference was detected regarding fusion rate and complication rate between groups (p>0.05), except the screw/rod failure rate (p<0.05). Radiographic analysis showed that the LLs in all these groups got improved (p<0.05) and the SLs maintained (p>0.05).
  
  
  CONCLUSIONS
  UPS or UPSFS instrumented TLIF could achieve satisfactory mid-term clinical outcome comparable to BPS's, with less surgical time, less blood loss, and lower cost; UPS should be prudently performed for two-level cases in case of lower fusion rate, and cannulated screws should be replaced by stronger solid screws in UPSFS to reduce facet screw breakage.
authors.affiliation: Department of Orthopaedics, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, China.
authors.forename: Fubing
authors.initials: F
authors.lastname: Liu
authors.affiliation: Department of Orthopaedics, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, China.
authors.forename: Yuanwu
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Department of Orthopaedics, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, China.
authors.forename: Zhenzhou
authors.initials: Z
authors.lastname: Feng
authors.affiliation: Department of Orthopaedics, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, China.
authors.forename: Xiaogang
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Orthopaedics, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Jiang
authors.affiliation: Department of Orthopaedics, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, China.
authors.forename: Xilei
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, China.
authors.forename: Zixian
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Orthopaedics, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Liang
authors.affiliation: Department of Orthopaedics, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, China. Electronic address: matthewtx@163.com.
authors.forename: Xiaoxing
authors.initials: X
authors.lastname: Jiang
authors.affiliation: Department of Orthopaedics, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, China. Electronic address: dong.jian@zs-hospital.sh.cn.
authors.forename: Jian
authors.initials: J
authors.lastname: Dong
mesh_terms: D000368:Aged; D001863:Bone Screws / Q000592:standards*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators / Q000592:standards; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019636:Neurodegenerative Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods* / Q000592:standards*; D013997:Time Factors
keywords: Fixation; Lumbar degenerative diseases; Posterior; Transforaminal lumbar interbody fusion; Two-level