Simultaneous Single-Position Lateral Lumbar Interbody Fusion Surgery and Unilateral Percutaneous Pedicle Screw Fixation for Spondylolisthesis

Abstract

Objective: To evaluate the clinical and radiological efficacy of a combine of lateral single screw-rod and unilateral percutaneous pedicle screw fixation (LSUP) for lateral lumbar interbody fusion (LLIF) in the treatment of spondylolisthesis.

Methods: Sixty-two consecutive patients with lumbar spondylolisthesis who underwent minimally invasive (MIS)-TLIF with bilateral pedicle screw (BPS) or LLIF-LSUP were retrospectively studied. Segmental lordosis angle (SLA), lumbar lordosis angle (LLA), disc height (DH), slipping percentage, the cross-sectional areas (CSA) of the thecal sac, screw placement accuracy, fusion rate and foraminal height (FH) were used to evaluate radiographic changes postoperatively. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical efficacy.

Results: Patients who underwent LLIF-LSUP showed shorter operating time, less length of hospital stay and lower blood loss than MIS-TLIF. No statistical difference was found between the 2 groups in screw placement accuracy, overall complications, VAS, and ODI. Compared with MIS-TLIF-BPS, LLIF-LSUP had a significant improvement in sagittal parameters including DH, FH, LLA, and SLA. The CSA of MIS-TLIF-BPS was significantly increased than that of LLIF-LSUP. The fusion rate of LLIF-LSUP was significantly higher than that of MIS-TLIF-BPS at the follow-up of 3 months postoperatively, but there was no statistical difference between the 2 groups at the follow-up of 6 months, 9 months, and 12 months.

Conclusion: The overall clinical outcomes and complications of LLIF-LSUP were comparable to that of MIS-TLIF-BPS in this series. Compared with MIS-TLIF-BPS, LLIF-LSUP for lumbar spondylolisthesis represents a significantly shorter operating time, hospital stay and lower blood loss, and demonstrates better radiological outcomes to maintain lumbar lordosis, and reveal an overwhelming superiority in the early fusion rate.

Keywords: Minimally invasive surgical procedures; Pedicle screws; Single-position; Spinal fusion; Spondylolisthesis.

Fig. 1.

A series of surgical photographs for key procedures of lateral lumbar interbody fusion combined lateral single screw-rod and unilateral percutaneous pedicle screw fixation. (A–D) Marked lines for the target intervertebral disc were obtained by C-arm fluoroscopy. (E–H) The patient underwent unilateral percutaneous pedicle screw fixation in single-lateral decubitus position. (I– L) Spondylolisthesis reduction, screws, cage, and connecting rod insertion were performed simultaneously.

Fig. 2.

A schematic diagram for surgical technique. (A) Normal vertebral sequence. (B) Lumbar spondylolisthesis. (C) Unilateral percutaneous pedicle screws fixation was performed and the screw cap of the inferior vertebra was gradually locked but the screw cap of the superior vertebra was incompletely locked. (D) spondylolisthesis reduction, screws, cage, and connecting rod insertion were performed simultaneously. (E) The lateral screws penetrated the contralateral cortex.

Fig. 3.

Typical cases in lateral lumbar interbody fusion combined lateral single screw-rod and unilateral percutaneous pedicle screw fixation (A–D) and minimally invasive transforaminal lumbar interbody fusion with bilateral pedicle screw (E–H) before operation and at 1 day, 1 month, and 12 months postoperatively.