Management of recurrent unilateral lumbar disc herniation in a single level: unilateral versus bilateral pedicle screws fixation with interbody fusion

Abstract

Background: Lumbar interbody fusion procedure is a recognized surgical technique in management of a variety of lumbar pathologies including recurrent lumbar disc prolapse. Interbody fusion augmented by pedicle screw fixation has been considered to improve fusion rates and clinical outcomes. Interbody fusion is commonly associated with better fusion potentials through applying the bone graft in the load bearing, vascular position of the anterior, and middle spinal columns. However, it still remains unknown whether interbody fusion with unilateral pedicle screw fixation (UPSF) is superior to that with bilateral pedicle screw fixation (BPSF). Aim of the work: The aim of this study is to evaluate the efficacy and safety of unilateral versus bilateral pedicle screw fixation associated with interbody fusion for the management of single level unilateral recurrent lumbar disc prolapse as regard the clinical and biomechanical results, operation time, intraoperative blood loss, and postoperative stay. Material and methods: This observational prospective comparative study of the two groups who were operated either unilateral (group A /15 patients) or bilateral (group B/15 patients) pedicle screw fixation with interbody fusion was done. Patients were followed up for 1, 6, ad 12 months. Results: Significant improvement in functional outcome of the two groups was noted compared to preoperatively, except in early postoperative period where the back VAS and ODI in the unilateral group was better than bilateral group. However, on further follow up, no significant difference was noticed. There was no significant difference comparing fusion rate, complication rate, and duration of hospital stay between the two groups at postoperative follow-up. There was significantly less blood loss, and significantly shorter operation time in the unilateral PS fixation group as compared with the bilateral PS fixation group in our study. Conclusion: Our study suggested that TLIF with unilateral PS fixation was as safe and effective as that with bilateral PS fixation for the management of recurrent single level lumbar disc prolapse; it showed better clinical outcome scores of ODI and back VAS, and a significant reduction of the intraoperative blood loss as well as the operation time, without significant differences considering fusion rate, complication rate, and duration of hospital stay between the two groups at postoperative follow-up. However, BPSF with TLIF likely causes more degeneration at the cranial adjacent segment compared with UPSF techniques. Nevertheless, the long-term follow up is required to demonstrate the impact of these findings.

Safety and efficacy of unilateral and bilateral pedicle screw fixation for lumbar degenerative diseases by transforaminal lumbar interbody fusion: An updated systematic review and meta-analysis

“…VAS-Leg pain score was evaluated in 8 studies including 518 patients ( 20 , 21 , 23 , 25 , 27 , 29 , 31 , 32 ). The results of the fixed-effect model meta-analysis showed that: the overall difference between UPSF and BPSF was not statistically significant [SMD = 0.18, 95% CI (−0.00–0.36), P = 0.05; Figure 3 ].…”

“…Operation time was evaluated in 10 studies including 682 patients ( 20 , 21 , 23 – 25 , 27 – 30 , 33 ). The results of the random-effect model meta-analysis showed that: compared with BPSF, the overall difference between UPSF and BPSF was statistically significant, and the operation time of UPSF was shorter [SMD = −1.75, 95% CI (−2.46 to −1.03), P < 0.000 01; Figure 6 ].…”

“…ODI score was evaluated in 13 studies including 852 patients (20, 21, [23][24][25][26][27][28][29][30][31][32][33]. The results of the fixed-effect model metaanalysis showed that: compared with BPSF, the overall difference between UPSF and BPSF was statistically significant, the ODI score after BPSF was lower, and the degree of lumbar spine dysfunction was less [SMD = 0.19, 95% CI (0.05-0.33), P = 0.007; Figure 4].…”