Unilateral versus Bilateral Pedicle Screw Fixation Combined with Transforaminal Lumbar Interbody Fusion for the Treatment of Low Lumbar Degenerative Disc Diseases: Analysis of Clinical and Radiographic Results
Unilateral versus Bilateral Pedicle Screw Fixation Combined with Transforaminal Lumbar Interbody Fusion for the Treatment of Low Lumbar Degenerative Disc Diseases: Analysis of Clinical and Radiographic Results
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单侧与双侧椎弓根螺钉固定联合经椎间孔腰椎椎间融合术治疗低位腰椎退变性椎间盘疾病：临床和影像学结果分析
DOI：
10.1016/j.wneu.2018.04.085
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发表时间：
2018-07-01
影响因子：
2
通讯作者：
Wan, Zongmiao
中科院分区：
文献类型：
--
作者：
Chen, De-jian;Yao, Cong;Wan, Zongmiao
目的：比较单侧经椎间孔腰椎椎间融合术（TLIF）后单侧椎弓根螺钉内固定术（UPSF）与双侧椎弓根螺钉内固定术（BPSF）治疗腰椎退变性椎间盘疾病（DDDs）的临床及影像学结果。 方法： 共63例患者接受UPSF或BPSF联合单侧TLIF治疗。 本分析纳入我院2014年至2016年期间的L4-L5或L5-S1。在术前和术后随访时记录围手术期结果和影像学结果。融合率根据 Bridwell-Lenke 分级系统确定。采用视觉模拟量表、Oswestry残疾指数和腰椎日本骨科协会评分来评估临床结果。结果：根据围手术期评估，UPSF组的手术时间、术中和术后失血量、止痛药使用时间和住院费用均显着（P < 0.0001）低于BPSF组。平均随访 24 个月后，UPSF 和 BPSF 组均显着（P < 0.05）保持手术节段的椎间盘高度和节段前凸，并在最终术后随访中取得相似的临床结果。短期内UPSF组对颅邻近椎体水平的影响明显小于BPSF组（P < 0.05）。结论：UPSF技术联合TLIF治疗单节段低腰椎DDD可达到与BPSF技术相似的临床疗效，但手术损伤较少，成本较低。与 UPSF 技术相比，BPSF 联合 TLIF 可能会导致颅骨邻近节段更多的退化。长期结果需要更多研究。
OBJECTIVE: To compare the clinical and radiographic results of unilateral pedicle screw fixation (UPSF) and bilateral pedicle screw fixation (BPSF) after unilateral transforaminal lumbar interbody fusion (TLIF) for the treatment of lumbar degenerative disc diseases (DDDs).METHODS: A total of 63 patients who underwent UPSF or BPSF combined with unilateral TLIF at L4-L5 or L5-S1 in our hospital between 2014 and 2016 were included in this analysis. The perioperative outcomes and radiographic results were recorded at preoperative and postoperative follow-up. Fusion rates were determined according to the Bridwell-Lenke grading system. Clinical outcomes were evaluated using the visual analog scale, Oswestry Disability Index, and lumbar Japanese Orthopedic Association score.RESULTS: According to the perioperative assessment, the duration of operation, intraoperative and postoperative blood loss, duration of pain medication use, and hospital costs were significantly (P < 0.0001) lower in the UPSF group compared with the BPSF group. After a mean follow-up of 24 months, both the UPSF and BPSF groups showed significantly (P < 0.05) maintained disc height and segmental lordosis of the surgical segment and achieved similar clinical outcomes at the final postoperative follow-up. The impact on the cranial adjacent vertebral level was significantly (P < 0.05) less in the UPSF group than the BPSF group in the short term.CONCLUSIONS: UPSF techniques with TLIF can attain similar clinical efficiency as BPSF techniques in treating single-level low lumbar DDD, but with fewer surgical injuries and at lower cost. BPSF with TLIF likely causes more degeneration at the cranial adjacent segment compared with UPSF techniques. The long-term results require more study.