Department of Orthopedic Surgery, Shanghai Key Laboratory of Orthopedic Implants, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China.
Department of Orthopedic Surgery, Shanghai Key Laboratory of Orthopedic Implants, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China.
Spine J. 2022 Oct;22(10):1687-1693. doi: 10.1016/j.spinee.2022.05.011. Epub 2022 Jun 7.
Transforaminal lumbar interbody fusion (TLIF) with bilateral pedicle screw fixation (BPSF) is an effective treatment for lumbar foraminal stenosis (LFS). However, the effects of TLIF with unilateral pedicle screw fixation (UPSF) on LFS treatment have not been clearly elucidated.
We conducted this study to compare clinical outcomes and radiographic results of TLIF with UPSF and BPSF 2 years after the surgical treatment.
Prospective randomized study.
This study included 23 patients undergoing TLIF with UPSF and 25 patients undergoing TLIF with BPSF.
Clinical outcomes were evaluated by visual analog scale (VAS) for low back pain and leg pain and Oswestry Disability Index (ODI) score. Radiographic outcomes included foraminal height, disc space height, segmental lordosis, and final fusion rates.
The clinical and radiographic outcomes were compared between the UPSF and BPSF group. The postoperative improvements were evaluated in either group. Intraoperative data such as duration of operation and estimated blood loss were collected. This study was registered at clinicaltrials.gov.
Analysis of the VAS and ODI scores showed significant improvements in clinical outcomes within each group. No significant differences between the 2 groups were noted in the improvements of the VAS and ODI scores. The mean operative duration and blood loss were significantly greater in the BPSF group than in the UPSF group. There were significant improvements in the height of the foramen and intervertebral space and segmental lordosis in both groups, while there was no significant difference between the groups in amount of the improvements. No significant difference was found in the final fusion rates.
TLIF is an appropriate procedure for LFS treatment. With balanced intervertebral support using a cage, UPSF could achieve similar and satisfactory effects on lumbar segmental stability and fusion compared to BPSF. The unilateral approach appears to be associated with slightly shorter operative time and less blood loss.
经椎间孔腰椎体间融合术（TLIF）联合双侧椎弓根螺钉固定（BPSF）是治疗腰椎侧隐窝狭窄症（LFS）的有效方法。然而，TLIF 联合单侧椎弓根螺钉固定（UPSF）治疗 LFS 的效果尚不清楚。
本研究旨在比较 TLIF 联合 UPSF 和 BPSF 治疗 LFS 术后 2 年的临床和影像学结果。
前瞻性随机研究。
本研究纳入了 23 例接受 TLIF 联合 UPSF 治疗的患者和 25 例接受 TLIF 联合 BPSF 治疗的患者。
临床疗效采用视觉模拟评分（VAS）评估腰痛和腿痛，采用 Oswestry 功能障碍指数（ODI）评分评估。影像学评估包括椎间孔高度、椎间盘高度、节段后凸角和最终融合率。
比较 UPSF 和 BPSF 组之间的临床和影像学结果。评估两组的术后改善情况。收集手术时间和估计失血量等术中数据。本研究在 clinicaltrials.gov 注册。
两组 VAS 和 ODI 评分均有显著改善，但两组间改善程度无显著差异。BPSF 组的手术时间和失血量均显著高于 UPSF 组。两组椎间孔高度和椎间盘高度以及节段后凸角均有显著改善，但两组间改善程度无显著差异。最终融合率无显著差异。
TLIF 是治疗 LFS 的一种合适方法。使用 cage 进行椎间平衡支撑，UPSF 可获得与 BPSF 相似的腰椎节段稳定性和融合效果。单侧入路似乎与较短的手术时间和较少的失血有关。
