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CC BY 4.0 · Indian Journal of Neurosurgery
DOI: 10.1055/s-0044-1791758
Original Article

Novel Technique for Degenerative Lumbar Spine Fusion: Unilateral Pedicle Screw Fixation Combined with Contralateral Interbody Cage Fusion for Posterior Lumbar Interbody Fusion

Wael Abdel Rahman Ali Elmesallamy 
1   Department of Neurosurgery, Faculty of Human Medicine, Zagazig University, Alsharkia, Egypt
,
Mohammed Elbanna
1   Department of Neurosurgery, Faculty of Human Medicine, Zagazig University, Alsharkia, Egypt
,
Mohammed Fahmy
1   Department of Neurosurgery, Faculty of Human Medicine, Zagazig University, Alsharkia, Egypt
,
Amr AlBakry
1   Department of Neurosurgery, Faculty of Human Medicine, Zagazig University, Alsharkia, Egypt
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Abstract

Objective The common traditional surgical techniques for posterior lumbar interbody fusion (PLIF) and fixation are bilateral pedicle screw fixation with or without interbody cage fusion and unilateral pedicle screw fixation with ipsilateral cage fusion. However, the novel unilateral pedicle screw fixation combined with the contralateral interbody cage fusion technique may provide the benefits and avoid the hazards of those traditional techniques. This prospective randomized comparative clinical trial aims to compare pedicle screw fixation with contralateral interbody cage fusion and unilateral pedicle screw fixation with ipsilateral cage fusion in single-level PLIF and fixation.

Methods This comparative prospective study was conducted on 60 patients subjected to a single-level PLIF and unilateral pedicle screw fixation during the period from January 2022 to July 2022 to compare two different surgical modalities: group A (unilateral pedicle screw fixation with contralateral interbody cage fusion) and group B (unilateral pedicle screw fixation with ipsilateral cage fusion).

Results Operative time, blood loss, operative complications, and visual analog scale improvements showed insignificant differences between the two groups, while group A showed significant improvements in the Oswestry Disability Index and wider coronal disc heights contralateral to the screw, which is the side of the cages, during postoperative follow-up.

Conclusion Unilateral pedicle screw fixation with contralateral cage fusion during the PLIF and pedicle screw fixation procedure is preferred to maintain bilateral coronal disc heights and thus better clinical and mechanical results without affection of the preceding disc.

Keywords

unilateral pedicle screw fixation - lumbar spine fusion - contralateral cage fusion


Publication History

Article published online:
21 October 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Liao Y, Ye R, Tang Q. et al. Application of ultrasonic osteotome in the posterior lumbar interbody fusion surgery by unilateral fenestration and bilateral decompression in the treatment of degenerative lumbar spinal stenosis [in Chinese]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019; 33 (04) 416-422
    PubMedSearch in Google Scholar
  • 2 Villavicencio AT, Burneikiene S, Bulsara KR, Thramann JJ. Perioperative complications in transforaminal lumbar interbody fusion versus anterior-posterior reconstruction for lumbar disc degeneration and instability. J Spinal Disord Tech 2006; 19 (02) 92-97
    CrossrefPubMedSearch in Google Scholar
  • 3 Zhang CM, Li HY, Li SS, Zhu Z, Yang K, Sun TS. Dynesys and posterior decompression and fusion internal fixation for the treatment of lumbar degenerative diseases: a systematic review [in Chinese]. Zhongguo Gu Shang 2018; 31 (06) 569-576
    PubMedSearch in Google Scholar
  • 4 Patel DV, Yoo JS, Karmarkar SS, Lamoutte EH, Singh K. Interbody options in lumbar fusion. J Spine Surg 2019; 5 (Suppl. 01) S19-S24
    CrossrefPubMedSearch in Google Scholar
  • 5 Lv QB, Gao X, Pan XX. et al. Biomechanical properties of novel transpedicular transdiscal screw fixation with interbody arthrodesis technique in lumbar spine: a finite element study. J Orthop Translat 2018; 15 (15) 50-58
    CrossrefPubMedSearch in Google Scholar
  • 6 Lee DY, Park YJ, Song SY, Jeong ST, Kim DH. Risk factors for posterior cage migration after lumbar interbody fusion surgery. Asian Spine J 2018; 12 (01) 59-68
    CrossrefPubMedSearch in Google Scholar
  • 7 Oliveira L, Marchi L, Coutinho E, Pimenta L. A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural elements. Spine 2010; 35 (26, Suppl): S331-S337
    CrossrefPubMedSearch in Google Scholar
  • 8 Hu XQ, Wu XL, Xu C. et al. A systematic review and meta-analysis of unilateral versus bilateral pedicle screw fixation in transforaminal lumbar interbody fusion. PLoS One 2014; 9 (01) e87501
    CrossrefPubMedSearch in Google Scholar
  • 9 Li H, Wang Z, Zhao J. et al. Effects of unilateral and bilateral pedicle screw fixation on symptoms and quality of life of patients with lumbar degenerative diseases. Am J Transl Res 2021; 13 (05) 5216-5223
    PubMedSearch in Google Scholar
  • 10 McKissack HM, Levene HB. Does the cage position in transforaminal lumbar interbody fusion determine unilateral versus bilateral screw placement?: a review of the literature. Asian Spine J 2019; 13 (02) 325-333
    CrossrefPubMedSearch in Google Scholar
  • 11 Gopinath P. Lumbar segmental instability: points to ponder. J Orthop 2015; 12 (04) 165-167
    CrossrefPubMedSearch in Google Scholar
  • 12 White III AA, Panjabi II MM. eds. Clinical Biomechanics of the Spine. Philadelphia: JB Lippincott; 1990: 590-608
    Search in Google Scholar
  • 13 Pickhardt PJ, Pooler BD, Lauder T, del Rio AM, Bruce RJ, Binkley N. Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med 2013; 158 (08) 588-595
    CrossrefPubMedSearch in Google Scholar
  • 14 Marchi L, Abdala N, Oliveira L, Amaral R, Coutinho E, Pimenta L. Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion. J Neurosurg Spine 2013; 19 (01) 110-118
    CrossrefPubMedSearch in Google Scholar
  • 15 Bridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K. Anterior structural allografts in the thoracic and lumbar spine. Spine 1995; 20: 1410-1418
    PubMedSearch in Google Scholar
  • 16 Huskisson EC, Jones J, Scott PJ. Application of visual-analogue scales to the measurement of functional capacity. Rheumatol Rehabil 1976; 15 (03) 185-187
    CrossrefPubMedSearch in Google Scholar
  • 17 Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine 2000; 25 (22) 2940-2952 , discussion 2952
    CrossrefPubMedSearch in Google Scholar
  • 18 Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J 2008; 17 (03) 327-335
    CrossrefPubMedSearch in Google Scholar
  • 19 Nie T, Chen DJ, Tang B. et al. In vivo dynamic motion characteristics of the lower lumbar spine: L4-5 lumbar degenerative disc diseases undergoing unilateral or bilateral pedicle screw fixation combined with TLIF. J Orthop Surg Res 2019; 14 (01) 171
    CrossrefPubMedSearch in Google Scholar
  • 20 Zhao C-Q, Ding W, Zhang K, Zhao J. Transforaminal lumbar interbody fusion using one diagonal fusion cage with unilateral pedicle screw fixation for treatment of massive lumbar disc herniation. Indian J Orthop 2016; 50 (05) 473-478
    CrossrefPubMedSearch in Google Scholar
  • 21 Lu P, Pan T, Dai T, Chen G, Shi KQ. Is unilateral pedicle screw fixation superior than bilateral pedicle screw fixation for lumbar degenerative diseases: a meta-analysis. J Orthop Surg Res 2018; 13 (01) 296
    CrossrefPubMedSearch in Google Scholar
  • 22 Nayak AN, Gutierrez S, Billys JB, Santoni BG, Castellvi AE. Biomechanics of lateral plate and pedicle screw constructs in lumbar spines instrumented at two levels with laterally placed interbody cages. Spine J 2013; 13 (10) 1331-1338
    CrossrefPubMedSearch in Google Scholar
  • 23 Castellvi AD, Thampi SK, Cook DJ. et al. Effect of TLIF cage placement on in vivo kinematics. Int J Spine Surg 2015; 9: 38
    CrossrefPubMedSearch in Google Scholar
  • 24 Faundez AA, Mehbod AA, Wu C, Wu W, Ploumis A, Transfeldt EE. Position of interbody spacer in transforaminal lumbar interbody fusion: effect on 3-dimensional stability and sagittal lumbar contour. J Spinal Disord Tech 2008; 21 (03) 175-180
    CrossrefPubMedSearch in Google Scholar
  • 25 Choi UY, Park JY, Kim KH. et al. Unilateral versus bilateral percutaneous pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion. Neurosurg Focus 2013; 35 (02) E11
    CrossrefPubMedSearch in Google Scholar