Unilateral Pedicle Screw Fixation with Bone Graft vs. Bilateral Pedicle Screw Fixation with Bone Graft or Cage: A Comparative Study

Abstract

BackgroundThe aim of this study was to explore the clinical efficacy of unilateral pedicle screw fixation with bone graft (UPSFB) in treating single-segment lumbar degenerative diseases (LDD), as compared to bilateral pedicle screw fixation with bone graft (BPSFB) or with cage (BPSFC).Material/MethodsMedical records were retrospectively collected between 01/2010 and 02/2015 in Longyao County Hospital. According to surgical methods used, all patients were divided into 3 groups: UPSFB group, BPSFB group, and BPSFC group. Clinical outcomes were evaluated by blood loss, blood transfusion, duration of operation, hospital stay, postoperative complications, interbody fusion rate, reoperation rate, medical expenses, patient satisfaction survey, and JOA score.ResultsNinety-five patients were included and underwent 2.5-year follow-up, with 7 patients lost to regular follow-up. As compared to the BPSFB group and BPSFC group, the UPSFB group had less blood loss and less blood transfusion, as well as shorter hospital stay (p<0.05). Medical expenses were far lower in the UPSFB group (p<0.001). There were no significant differences among the 3 groups in postoperative complications, interbody fusion rate, reoperation rate, JOA score, and patient satisfaction (all p>0.05).ConclusionsAs compared to BPSFB and BPSFC, UPSFB has the same reliability and effectiveness in treating single-segment LDD with unilateral radicular symptoms in a single lower extremity, with the additional advantage being less expensive.

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

“…The use of bilateral PS fixation is associated with another drawback which is more blood loss, since it is inevitable to have more blood loss during neural elements decompression along with screws application on both sides. This is a clear-cut fact reported in all studies [2,8,19,23,24].…”

“…Intraoperative complications included unintended durotomy that took place in three patients, two in the bilateral group and a single case in the unilateral group, where the dural tear was repaired intraoperatively via dural sutures augmented by a fat graft and no lumbar drain was required. Yang et al [24] reported also three cases to have a dural tear, again one in unilateral group and two in bilateral group. All were managed conservatively as well with no occurrence of any further complications.…”

“…In fact, traditionally practiced bilateral pedicle screw fixation (BPSF) and instrumentation performed together with TLIF can be regarded as a reliable and effective surgery for sufficient fusion [16]. On the other hand, it is reported that extreme rigidity caused by bilateral screw fixation may possibly contribute to a higher incidence of adjacent segment disease (ASD) [24]. On the other hand, it is reported in the literature that unilateral pedicle screw fixation (UPSF) with the TLIF procedure has many advantages compared to BPSF including being a less invasive surgical procedure, with shorter operation time, less blood loss, less co-morbidities, less postoperative pain, and less cost [26].…”

Comparison of unilateral versus bilateral pedicle screw fixation in transforaminal lumbar interbody fusion for single level lumbar degenerative diseases and review of literature.

“…Subsidence of bone graft and decline in bone mineral cause a decrease in fusion rates. (6,12,18,25,(39)(40)(41). Likewise, it is reported in the literature that unilateral pedicle fixation with the TLIF procedure has many advantages compared to bilateral PSF.…”

Biomechanical investigation into the structural design of porous additive manufactured cages using numerical and experimental approaches

“…Both a posterior screw-rod fixation system and solid intervertebral cages were selected for the PLIF surgery [4,5].…”