Advertisement

European Spine Journal

, Volume 24, Issue 8, pp 1640–1648 | Cite as

Clinical and radiological outcomes of unilateral versus bilateral instrumentation in two-level degenerative lumbar diseases

  • Guangfei Gu
  • Hailong Zhang
  • Guoxin Fan
  • Shisheng HeEmail author
  • Xiaotong Meng
  • Xin Gu
  • Ning Yan
  • Xiaofei Guan
Original Article

Abstract

Purpose

To compare the clinical and radiological outcomes of unilateral versus bilateral instrumented in two-level degenerative lumbar diseases after minimally invasive transforaminal lumbar interbody fusion (MITLIF).

Methods

We conducted a prospective cohort study of 74 patients, who underwent unilateral or bilateral instrumented in two-level MITLIF for degenerative lumbar diseases from May 2010 to June 2012. There were 35 patients in group A undergoing unilateral pedicle screw fixation and 39 patients in group B undergoing bilateral pedicle screw fixation. Demographic data and clinical characteristics were compared between the two groups before surgery. Perioperative data, clinical and radiological outcomes of the two groups were also compared.

Results

The mean follow-up period was 32.1 ± 7.5 months for group A and 31.7 ± 8.0 months for group B (p > 0.05). Group A required a significantly shorter operating time, lower implant costs and less intraoperative blood loss and X-ray exposure time than group B (p < 0.01). However, no statistical differences were identified in the amount of transfusion and postoperative hospital stay between the two groups (p > 0.05). Clinical outcomes assessed by visual analog scores for back and leg pain (VAS-BP and VAS-LP, respectively) and Oswestry Disability Index (ODI) improved significantly in both groups after surgery, and no significant differences existed between the two groups at each postoperative follow-up (p > 0.05). There were significant differences within groups for Cobb angles of the whole lumbar [Cobb (a)] and the whole lumbar lordosis at each time point before and after surgery (p < 0.05). No significant differences existed between groups in relation to Cobb (a), Cobb angle of the fused segments, lumbar lordosis and the segmental lordosis at any time point before and after surgery (p > 0.05). There were no significant differences in fusion rate and total complication rate between the two groups (p > 0.05).

Conclusions

Unilateral instrumentation after two-level MITLIF provided similar clinical and radiological outcomes to bilateral fixation in two-level degenerative lumbar diseases. Compared with bilateral fixation, unilateral fixation shortens operation time, reduces intra-operative blood loss and X-ray exposure time, and saves medical expenses with similar postoperative hospital stay and complication rate.

Keywords

Transforaminal lumbar interbody fusion Minimally invasive Unilateral Bilateral Radiographic analysis 

Notes

Acknowledgments

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Conflict of interest

None of the authors has any potential conflict of interest.

References

  1. 1.
    Goel VK, Lim TH, Gwon J, Chen JY et al (1991) Effects of rigidity of an internal fixation device. A comprehensive biomechanical investigation. Spine (Phila Pa 1976) 16(3 Suppl):S155–S161CrossRefGoogle Scholar
  2. 2.
    McAfee PC, Farey ID, Sutterlin CE, Gurr KR, Warden KE, Cunningham BW (1991) The effect of spinal implant rigidity on vertebral bone density. A canine model. Spine (Phila Pa 1976) 16(6 Suppl):S190–S197CrossRefGoogle Scholar
  3. 3.
    McAfee PC, Farey ID, Sutterlin CE, Gurr KR, Warden KE, Cunningham BW (1989) 1989 Volvo award in basic science. Device-related osteoporosis with spinal instrumentation. Spine (Phila Pa 1976) 14(9):919–926CrossRefGoogle Scholar
  4. 4.
    Nagata H, Schendel MJ, Transfeldt EE, Lewis JL (1993) The effects of immobilization of long segments of the spine on the adjacent and distal facet force and lumbosacral motion. Spine (Phila Pa 1976) 18(16):2471–2479CrossRefGoogle Scholar
  5. 5.
    Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE (2004) Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976) 29(17):1938–1944CrossRefGoogle Scholar
  6. 6.
    Shono Y, Kaneda K, Abumi K, McAfee PC, Cunningham BW (1998) Stability of posterior spinal instrumentation and its effects on adjacent motion segments in the lumbosacral spine. Spine (Phila Pa 1976) 23(14):1550–1558CrossRefGoogle Scholar
  7. 7.
    Schizas C, Tzinieris N, Tsiridis E, Kosmopoulos V (2009) Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience. Int Orthop 33(6):1683–1688PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Deutsch H, Musacchio MJ Jr (2006) Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation. Neurosurg Focus 20(3):E10PubMedCrossRefGoogle Scholar
  9. 9.
    Kasai Y, Inaba T, Kato T, Matsumura Y, Akeda K, Uchida A (2010) Biomechanical study of the lumbar spine using a unilateral pedicle screw fixation system. J Clin Neurosci 17(3):364–367PubMedCrossRefGoogle Scholar
  10. 10.
    Wang J, Zhou Y (2014) Perioperative complications related to minimally invasive transforaminal lumbar fusion: evaluation of 204 operations on lumbar instability at single center. Spine J 14(9):2078–2084PubMedCrossRefGoogle Scholar
  11. 11.
    Gu G, Zhang H, He S, Jia J, Fu Q, Zhou X (2013) Preoperative localization methods for minimally invasive surgery in lumbar spine: comparisons between a novel method and conventional methods. J Spinal Disord Tech 26(7):E277–E280PubMedCrossRefGoogle Scholar
  12. 12.
    Quint DJ, Tuite GF, Stern JD, Doran SE et al (1997) Computer-assisted measurement of lumbar spine radiographs. Acad Radiol 4(11):742–752PubMedCrossRefGoogle Scholar
  13. 13.
    Lee KH, Yue WM, Yeo W, Soeharno H, Tan SB (2012) Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion. Eur Spine J 21(11):2265–2270PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Sethi A, Lee S, Vaidya R (2009) Transforaminal lumbar interbody fusion using unilateral pedicle screws and a translaminar screw. Eur Spine J 18(3):430–434PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Foley KT, Lefkowitz MA (2002) Advances in minimally invasive spine surgery. Clin Neurosurg 49:499–517PubMedGoogle Scholar
  16. 16.
    Peng CW, Yue WM, Poh SY, Yeo W, Tan SB (2009) Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine (Phila Pa 1976) 34(13):1385–1389CrossRefGoogle Scholar
  17. 17.
    Schwender JD, Holly LT, Rouben DP, Foley KT (2005) Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech 18(Suppl):S1–S6PubMedCrossRefGoogle Scholar
  18. 18.
    Villavicencio AT, Burneikiene S, Roeca CM, Nelson EL, Mason A (2010) Minimally invasive versus open transforaminal lumbar interbody fusion. Surg Neurol Int 1:12PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J (2010) Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J 19(10):1780–1784PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Schleicher P, Beth P, Ottenbacher A, Pflugmacher R et al (2008) Biomechanical evaluation of different asymmetrical posterior stabilization methods for minimally invasive transforaminal lumbar interbody fusion. J Neurosurg Spine 9(4):363–371PubMedCrossRefGoogle Scholar
  21. 21.
    Slucky AV, Brodke DS, Bachus KN, Droge JA, Braun JT (2006) Less invasive posterior fixation method following transforaminal lumbar interbody fusion: a biomechanical analysis. Spine J 6(1):78–85PubMedCrossRefGoogle Scholar
  22. 22.
    Yucesoy K, Yuksel KZ, Baek S, Sonntag VK, Crawford NR (2008) Biomechanics of unilateral compared with bilateral lumbar pedicle screw fixation for stabilization of unilateral vertebral disease. J Neurosurg Spine 8(1):44–51PubMedCrossRefGoogle Scholar
  23. 23.
    Fernandez-Fairen M, Sala P, Ramirez H, Gil J (2007) A prospective randomized study of unilateral versus bilateral instrumented posterolateral lumbar fusion in degenerative spondylolisthesis. Spine (Phila Pa 1976) 32(4):395–401CrossRefGoogle Scholar
  24. 24.
    Dahdaleh NS, Nixon AT, Lawton CD, Wong AP, Smith ZA, Fessler RG (2013) Outcome following unilateral versus bilateral instrumentation in patients undergoing minimally invasive transforaminal lumbar interbody fusion: a single-center randomized prospective study. Neurosurg Focus 35(2):E13PubMedCrossRefGoogle Scholar
  25. 25.
    Sonmez E, Coven I, Sahinturk F, Yilmaz C, Caner H (2013) Unilateral percutaneous pedicle screw instrumentation with minimally invasive TLIF for the treatment of recurrent lumbar disk disease: 2 years follow-up. Turk Neurosurg 23(3):372–378PubMedGoogle Scholar
  26. 26.
    Suk KS, Lee HM, Kim NH, Ha JW (2000) Unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion. Spine (Phila Pa 1976) 25(14):1843–1847CrossRefGoogle Scholar
  27. 27.
    Xue H, Tu Y, Cai M (2012) Comparison of unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in degenerative lumbar diseases. Spine J 12(3):209–215PubMedCrossRefGoogle Scholar
  28. 28.
    Zhang K, Sun W, Zhao CQ, Li H et al (2014) Unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in two-level degenerative lumbar disorders: a prospective randomised study. Int Orthop 38(1):111–116PubMedCrossRefGoogle Scholar
  29. 29.
    Xiaolong S, Lei W, Hailong Z, Xin G, Guangfei G, Shisheng H (2013) Radiographic analysis of one-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) With unilateral pedicle screw fixation for lumbar degenerative diseases. J Spinal Disord Tech. doi: 10.1097/BSD.0000000000000042 PubMedGoogle Scholar
  30. 30.
    Mao L, Zhao J, Dai KR, Hua L, Sun XJ (2014) Bilateral decompression using a unilateral pedicle construct for lumbar stenosis. Int Orthop 38(3):573–578PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Guangfei Gu
    • 1
  • Hailong Zhang
    • 1
  • Guoxin Fan
    • 1
  • Shisheng He
    • 1
    Email author
  • Xiaotong Meng
    • 1
  • Xin Gu
    • 1
  • Ning Yan
    • 1
  • Xiaofei Guan
    • 1
  1. 1.Department of Orthopaedics, Shanghai Tenth People’s HospitalTongji University School of MedicineShanghaiPeople’s Republic of China

Personalised recommendations