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Randomized Controlled Trial
. 2014 Jan;38(1):111-6.
doi: 10.1007/s00264-013-2026-y. Epub 2013 Aug 6.

Unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in two-level degenerative lumbar disorders: a prospective randomised study

Kai Zhang  1 , Wei Sun, Chang-qing Zhao, Hua Li, Wei Ding, You-zhuan Xie, Xiao-jiang Sun, Jie Zhao
Affiliations
Randomized Controlled Trial

Unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in two-level degenerative lumbar disorders: a prospective randomised study

Kai Zhang et al. Int Orthop. 2014 Jan.

Abstract

Purpose: The aim of this study was to analyse the clinical and radiological outcomes of unilateral versus bilateral instrumented TLIF in two-level degenerative lumbar disorders.

Methods: A prospective randomised clinical study was performed from January 2008 to May 2011. Sixty-eight consecutive patients with severe low back pain and radicular pain were divided randomly into the unilateral (n = 33) or bilateral (n = 35) pedicle screw fixation group based on a random number list. Operative time, blood loss, duration of hospital stay, fusion rate, complication rate and implant costs were recorded and analysed statistically. Visual analog scale (VAS) scores, Oswestry Disability Index (ODI), and SF-36 were used to assess the preoperative and postoperative clinical results in the two groups.

Results: No differences were observed between the two groups with respect to demographic data. The patients of the two groups had significant improvement in functional outcome compared to preoperatively. There was no significant difference comparing fusion rate, complication rate and duration of hospital stay between the two groups at postoperative follow-up (P > 0.05). However, compared with the bilateral pedicle screw group, a significant decrease occurred in operative time, blood loss and implant costs in the unilateral group.

Conclusion: Two-level unilateral instrumented TLIF is an effective and safe method with reduced operative time and blood loss for multiple-level lumbar diseases. But it is imperative that the larger cage should be appropriately positioned to support the contralateral part of the anterior column by crossing the midline of the vertebral body.

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Figures

Fig. 1
Fig. 1
Follow-up anteroposterior and lateral radiographs of a 41-year-old man with L4-L5-S1 lumbar stenosis treated with decompression, interbody fusion, and unilateral pedicle screw fixation
Fig. 2
Fig. 2
A 73-year-old woman with L4-L5-S1 lumbar stenosis was found with proximal scoliosis three months after operation
See this image and copyright information in PMC

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