Minimally invasive unilateral pedicle screws and a translaminar facet screw fixation and interbody fusion for treatment of single-segment lower lumbar vertebral disease: surgical technique and preliminary clinical results

Abstract

BackgroundConventional open transforaminal lumbar interbody fusion (TLIF) using unilateral pedicle screws and a translaminar facet screw has been performed for many years with good results. The outcomes of minimally invasive TLIF (MIS TLIF) are similar to the good outcomes of open TLIF, with the additional benefits of reducing iatrogenic injury, shortening hospital stays, and reducing the recovery duration. Instead of using small cuts on both sides, we performed MIS TLIF through a single cut using unilateral pedicle screws and a translaminar facet screw. The operative feasibility, efficacy safety, and benefits of single-level MIS TLIF of such techniques require further clarification.MethodsA total of 60 patients with various single-segment lower lumbar vertebral diseases were treated in our department from January 2010 to March 2013. All the patients were initially performed single-level MIS TLIF using a hybrid construction of unilateral pedicle screws and a translaminar facet screw. Patient demographics and operative data were collected. The clinical outcomes were assessed before surgery and 3, 6, 12, and 24 months after surgery using the visual analog scale (VAS) for back and leg pain and the Oswestry Disability Index (ODI). Radiologic assessment of the lumbar spine with static and dynamic plain radiographs was performed 3, 6, 12, and 24 months after surgery. The fusion rates were assessed by an independent radiologist 2 years after surgery according to the Bridwell interbody fusion grading system.ResultsNo patients experienced significant postoperative complications. Excepting two cases, 58 cases were followed up for 24–38 months, averaged 29.9 ± 4.1 months. The patients’ average age was 46.6 ± 11.5 years, operative time 109.7 ± 17.8 min, intraoperative blood loss 67.3 ± 29.7 ml, length of incision 29.0 ± 3.2 mm, fluoroscopy time 31.1 ± 7.2 s, time to ambulation 20.3 ± 7.0 h, length of hospital stay 5.1 ± 1.1 days, and length of the translaminar facet screw 51.7 ± 3.4 mm. Screw position results: type I, 54 cases with 54 segments; type II, four cases with four segments. There were two (3.4%) translaminar facet screw failures, which were intraoperatively converted to a bilateral pedicle screw fixation procedure and excluded from the research. The postoperative images showed good positioning of the hybrid internal fixation, and all of the translaminar facet screws penetrated the facet joint. Two (3.6%) translaminar facet screws penetrated the lateral lamina and two (3.6%) translaminar facet screws penetrated the medial lamina without any serious neural complications. During the follow-up, there was no screw loosening or pedicle fracture observed. The VAS and ODI scores were significantly improved compared with the preoperative scores (P < 0.05), and the symptoms disappeared gradually. Fifty-one patients (87.9%) achieved grade I fusion radiographically at the final follow-up.ConclusionsMIS TLIF using a hybrid construction of unilateral pedicle screws and a translaminar facet screw is safe and effective in the trea...

Investigation of optical reflectance from different animal vertebra along the fixation trajectory of pedicle screw in frequency domain

“…Although bovine and ovine vertebrae are di®erent in structure from human vertebrae, they are similar in composition, used as vertebral models in some research. 12 We obtained di®erent animal vertebra spectrum according to nine sampling points along the trajectory. In Fig.…”

“…These models were chosen because porcine vertebra was similar to that of human, and bovine and ovine vertebrae were similar in composition, used as vertebral models in some research. 12 Our goal was to develop a di®erent method to analyze the characteristic of the corresponding spectrum and distinguish tissues according to the di®erent characteristics. [13][14][15] Along the¯xation trajectory of pedicle screw, average energy patterns used for identifying di®erent tissues were calculated in frequency domain.…”

Unilateral pedicle screw fixation with transforaminal interbody fusion (UNILIF): 52-patient prospective series

“…Bilateral screw fixation was first introduced but further research has revealed that unilateral screw fixation represents a good choice for preserving stability of the spine. 14,16,17 In spinal fusion surgery, the need for unilateral or bilateral instrumentation is a controversial matter. Biomechanical studies had demonstrated that unilateral fixation after TLIF delivered less rotational stability and stiffness than bilateral pedicle screw fixation.…”

Instrumentation Removal following Minimally Invasive Posterior Percutaneous Pedicle Screw-Rod Stabilization (PercStab) of Thoracolumbar Fractures Is Not Always Required

“…Surgical treatments are proposed to patients with unstable traumatic pathologies, with or without neurological deficit [3]. While traditional open surgical treatments are commonly used, they may result in considerable blood loss, complications, extended hospital stays, and delayed functional recovery [4][5][6][7]. Minimally invasive surgical (MIS) techniques are intended to minimize approach morbidity and associated complications of open surgeries [5].…”