Comparison of Unilateral versus Bilateral Pedicle Screw Fixation in Transforaminal Lumbar Interbody Fusion for Single Level Lumbar Degenerative Diseases and Review of Literature.

AIM: There are some recognized treatment modalities in the literature for the treatment of lumbar degenerative diseases,which cause pain and avoidance of daily life activities for the patients.The most widely accepted algorithm in the literature is medical treatment,physical therapy and minimally invasive pain-relieving therapies,if necessary,followed by surgical interventions.The common procedure used in neurosurgery practice is the decompression of neural elements followed by fusion.It is reported in the literature that unilateral pedicle fixation and Transforaminal Lumbar Interbody Fusion(TLIF) procedure have many advantages compared to bilateral pedicle screw implementation(PSF).We examined the clinical and radiological follow-up and results of our patients undergoing fusion procedure by unilateral versus bilateral pedicle screw fixation along with TLIF.

MATERIAL AND METHODS: 54 patients were included in the study.33 patients were operated with bilateral PSF and TLIF and 21 had unilateral PSF and TLIF.The patients were evaluated preoperatively,on the postoperative 15th day,6th and 12th month, and at the time of last examination (38 months in average for all patients) using Visual Analogue Scale(VAS) and Oswestry Disability Index(ODI).Fusion rates were examined with direct X-ray films with flexion-extension dynamic views and 3D CT scan.

RESULTS: Operation times are shorter and blood loss is less in the unilateral PSF group.Fusion rates are similar in both groups with no statistical significance.For both groups significant clinical improvement was observed in the preoperative and postoperative scores.

CONCLUSION: Unilateral PSF along with TLIF procedure is an effective option in selected patients.We need prospective randomized studies with higher number of patients and longer follow-up periods for more reliable results.