Unilateral pedicle screw fixation with interbody fusion in lumbar degenerative disease

Abstract

Unilateral transpedicular screw is widely used in lumbar spine surgery due to its primary role in enhancing arthrodesis with less tissue damage when combined with posterolateral lumbar interbody fusion (PLIF). Unilateral instrumentation can achieve similar outcomes to those of bilateral instrumentation. Its advantage is that it precludes the possibility of damaging the contralateral soft tissues and muscles. Our study assess the operative efficacy and benefits of unilateral pedicle screw (PS) fixation and decompression with interbody diagonal cage for lower lumbar degenerative diseases (LDD). A total of 60 consecutive patients who underwent either a bilateral or unilateral procedure (30 patients in each group) for treating lower LDD were included in this study. Radiological and clinical assessments were performed at 3, 6, and 12 months after surgery to assess interbody fusion rates and clinical outcomes. No significant differences were observed between the two cohorts regarding age, gender, weight, presence of comorbidities, or baseline neurologic deficit. The unilateral cases showed statistically significant less surgical trauma in terms of fluoroscopy time, operative time, intraoperative blood transfusion, and length of incision. The clinical and radiological outcomes in both cohorts were quite similar. Both unilateral and bilateral PS fixations with PLIF have quite similar outcomes for LDD. However, based on its minimal invasiveness, the unilateral approach can be an attractive alternative to bilateral instrumentation. Our study recommends unilateral short-segment fixation as an appropriate choice in selected cases.