Unilateral pedicle screw fixation with TLIF can achieve similar results to bilateral fixation for lumbar foraminal stenosis

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Transforaminal lumbar interbody fusion (TLIF) is an appropriate procedure for the treatment of lumbar foraminal stenosis (LFS) and, with balanced intervertebral support using a cage, unilateral pedicle screw fixation (UPSF) can achieve similar and satisfactory effects on lumbar segmental stability and fusion compared to bilateral pedicle screw fixation (BPSF).

These are the key findings from new research, published in The Spine Journal by Jie Zhao (Shanghai Ninth People’s Hospital, Shanghai, China) et al, which also showed that the unilateral approach appears to be associated with slightly shorter operative time and less blood loss.

The purpose of this prospective randomised study was to compare clinical outcomes and radiographic results of TLIF with UPSF and BPSF two years after the surgical treatment.

The study included 23 patients undergoing TLIF with UPSF and 25 patients undergoing TLIF with BPSF. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) for low back pain and leg pain as well as the 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 groups. The postoperative improvements were evaluated in either group. Intraoperative data such as duration of operation and estimated blood loss were collected.

Analysis of the VAS and ODI scores showed significant improvements in clinical outcomes within each group but there was no significant differences between the two groups in relation to improvements of the VAS and ODI scores.

The mean operative duration and blood loss were found to be 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. There was also no significant difference found in terms of final fusion rates.


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