Hegde Sajan Karunakar, Krishnan Appaji Krishnamurthy, Badikkillaya Vigneshwara, Achar Sharan Talacauvery, Reddy Harith Baddula, Alagarasan Akshyaraj, Venkataramanan Rochita
Department of Orthopaedics, Apollo Hospitals, Chennai, India.
Department of Radiology, Advantage Imaging and Research Institute, Chennai, India.
Asian Spine J. 2024 Dec;18(6):846-855. doi: 10.31616/asj.2024.0230. Epub 2024 Dec 24.
Matched case-control study.
To evaluate the midterm outcomes of unilateral pedicle screw fixation (UPSF) versus bilateral pedicle screw fixation (BPSF) in transforaminal lumbar interbody fusion (TLIF) procedure, ascertain efficacy of UPSF in adequately decompressing contralateral foramen+spinal canal and reducing rate of adjacent segment degeneration (ASD) at 4-8-year follow-up (FU).
Previous meta-analyses found no significant differences between UPSF and BPSF regarding fusion rates, clinical and radiological outcomes; however, few studies have reported higher rates of cage migration/subsidence and pseudoarthrosis in the UPSF. No study has evaluated the impact of UPSF on indirect decompression and ASD.
Retrospective analysis of 319 patients treated with UPSF vs. 331 patients treated with BPSF between 2012 to 2020. Clinical and radiological outcomes were evaluated at 6 months, 1 year, 2 years, and 4 years postoperatively. X-rays were used to assess fusion+ASD and computed tomography scans in doubtful cases. Magnetic resonance imaging was used at last FU to determine cross-sectional area of cord (CSA), foraminal height (FH), and width (FW) restoration.
The mean FU duration was 50 months (range, 44-140 months). In UPSF, CSA increased by 2.3 times from preoperative values; FH and FW increased by 25% and 17.5%, respectively, at last FU (p<0.001); fusion rate was 94.3%, comparable to BPSF (similar CSA, FW, FH, 96.4% fusion rate). In UPSF, adjacent disc height remained stable, from preoperative 11.39±2.03 to 10.97±1.93 postoperatively at 4 years and 10.03±1.88 at 8 years. BPSF showed ASD in 14 (4.47%) vs. three patients (1.06%) in UPSF (p<0.04). Complication rates were similar (6.58% UPSF vs. 6.04% BPSF, p>0.05).
UPSF-TLIF is comparable to BPSF in terms of patient-reported clinical outcomes, fusion rates, and complication rates while being superior in terms of lesser ASD. UPSF enables radiologically and clinically significant contralateral indirect neural foraminal decompression and canal decompression without disturbing the contralateral side anatomy, unlike BPSF.
配对病例对照研究。
评估单侧椎弓根螺钉固定（UPSF）与双侧椎弓根螺钉固定（BPSF）在经椎间孔腰椎椎间融合术（TLIF）中的中期疗效，确定UPSF在4至8年随访期（FU）内充分减压对侧椎间孔和椎管以及降低相邻节段退变（ASD）发生率方面的疗效。
既往的荟萃分析发现，UPSF和BPSF在融合率、临床和影像学结果方面无显著差异；然而，少数研究报告了UPSF中椎间融合器移位/下沉和假关节形成的发生率较高。尚无研究评估UPSF对间接减压和ASD的影响。
对2012年至2020年间接受UPSF治疗的319例患者和接受BPSF治疗的331例患者进行回顾性分析。在术后6个月、1年、2年和4年评估临床和影像学结果。使用X线评估融合情况和ASD，对可疑病例进行计算机断层扫描。在最后一次随访时使用磁共振成像确定脊髓横截面积（CSA）、椎间孔高度（FH）和宽度（FW）的恢复情况。
平均随访时间为50个月（范围44至140个月）。在UPSF组，CSA较术前值增加了2.3倍；在最后一次随访时，FH和FW分别增加了25%和17.5%（p<0.001）；融合率为94.3%，与BPSF组相当（CSA、FW、FH相似，融合率为96.4%）。在UPSF组，相邻椎间盘高度保持稳定，术前为11.39±2.03，术后4年为10.97±1.93，8年为10.03±1.88。BPSF组有14例（4.47%）发生ASD，而UPSF组有3例（1.06%）（p<0.04）。并发症发生率相似（UPSF组为6.58%，BPSF组为6.04%，p>0.05）。
UPSF-TLIF在患者报告的临床结果、融合率和并发症发生率方面与BPSF相当，而在减少ASD方面更具优势。与BPSF不同，UPSF能够在不干扰对侧解剖结构的情况下实现对侧间接神经椎间孔减压和椎管减压，在影像学和临床上均具有显著意义。
