Evaluation of the Results of Unilateral Pedicular Fixation and Interbody Fusion in Treatment of Degenerative Lumbar Disc Disease

Abstract

Background data: Chronic discogenic back pain caused by degenerative disc disease is a common problem in general population. In clinical practice, lateral recess stenosis and foraminal stenosis may induce nerve root compression which can cause unilateral symptoms. Less invasive spinal fusion is performed by a unilateral approach, which may significantly minimize or diminish the iatrogenic soft tissue injury, the intra-operative blood loss, the postoperative pain and the duration of hospital stays. Purpose: to evaluate the efficacy of PLIF and unilateral pedicle screw fixation in degenerative lumbar disc disease Study Design: A prospective clinical case study. Patient and Methods: This study was carried out on 30 patients (16 males and 14 females) with mean age of 40.35±9.82 years. All failed conservative treatment and had confirmed diagnosis radiologically. All underwent posterior lumbar decompression, interbody fusion with single oblique cage filled with local bone and unilateral pedicle screw fixation. Clinical assessment was done using Visual Analogue Scale (VAS) and ODI. Radiological assessment of fusion was done using BSF criteria. Patients were followed for 17.77±7.17 months postoperatively. Results: According to ODI; 12 patients (40%) had excellent clinical results, 15 (50%) had good results, 3 (10%) had fair results. The mean VAS of leg pain improved from 6.80±1.37 to 2.17±0.91, where the VAS of back pain improved from 5.33±1.18 to 2.13±0.90 postoperative. All sensory and motor deficits cleared apart from 3 patients with mild leg paresthesia. Radiologically, 28 patients (93%) showed successful fusion at the end of the follow up period. Reported complications include, one (3.3%) wound infection, one (3.3) intra-operative dural tear, and two partial (grade 3) foot drop. There were two patients with pseudoarthrosis, although there was no case of implant failure or screw breakage. Conclusion: Our data suggest that conducting PLIF using the diagonal insertion of a single cage with supplemental unilateral transpedicular screw instrumentation enables sufficient decompression and solid interbody fusion. (2017ESJ152)