A Prospective Randomized Study of Unilateral Versus Bilateral Instrumented Posterolateral Lumbar Fusion in Degenerative Spondylolisthesis

Abstract

Unilateral instrumentation used for the treatment of degenerative lumbar spondylolisthesis is as effective as bilateral instrumentation when performed in addition to 1- or 2-level posterolateral fusion. The cost of this method is lower, saves time, and reduces possible risk inserting screws in only one side.

Unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in two-level degenerative lumbar disorders: a prospective randomised study

“…Several randomised controlled clinical trials have shown that there is no clinical benefit from bilateral over unilateral instrumentation in posterolateral fusion alone. The main benefits of unilateral fixation seem to be less blood loss and muscle dissection, shorter operative time and hospital stay, lower medical cost, and fewer complications related to implants [12,20,21,24]. These results were also observed in our study.…”

“…Lumbar interbody fusion can reach almost 100 % fusions, whereas the fusion rate of posterolateral arthrodesis with unilateral fusion ranges between 90 % and 97 %, especially with a lower rate in two-level fusion [11][12][13]25]. In this study, we found that the fusion rate of two-level fusion in the unilateral fixation group was similar to that in the bilateral fixation group (90.91 % vs 94.29 %).…”

“…Suk reported 15 cases (15/47) with two-level posterolateral fusion, but the fusion rate was not clearly recorded [11]. In a prospective randomised study of posterolateral arthrodesis, the failed fusion rate of two-level fusion was 18.75 (3/16) in the unilateral group, whereas it was 18.18 (2/11) in the bilateral group [12].…”

“…[17][18][19]. Some clinical and biomechanical studies on the suitability of unilateral pedicle screw fixation have demonstrated that reliable fusion with fewer pedicle screws can be achieved [11][12][13][20][21][22][23]. Therefore, the need for unilateral or bilateral instrumentation is a matter for debate.…”

“…Suk et al and Fernandez-Fairen et al concluded that no difference exists in long-term radiographic or clinical outcome between bilateral and unilateral instrumentation in posterolateral fusion [11,12]. More recently, bilateral and unilateral pedicle screw fixation techniques have been used in minimally invasive surgery (MIS) [6].…”