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Randomized Controlled Trial
. 2025 Apr 26;20(1):420.
doi: 10.1186/s13018-025-05821-0.

Clinical efficacy and quality of life in elderly patients with lumbar degenerative disease treated with TLIF combined with unilateral pedicle screw fixation: a randomized controlled study

Cheng-Peng Li #  1 , Kai-Kai Feng #  1 , Xiao-Bing Xiang  2 , Kai-Yin Gao  3 , Wei-Wei Zhang  1 , Zhen-Yu Nie  1 , Dong Zhao  1 , Wen-Xin Liao  1 , Guang-Ru Cao  4
Affiliations
Randomized Controlled Trial

Clinical efficacy and quality of life in elderly patients with lumbar degenerative disease treated with TLIF combined with unilateral pedicle screw fixation: a randomized controlled study

Cheng-Peng Li et al. J Orthop Surg Res. .

Abstract

Objective: To conduct a comparative analysis of the clinical efficacy and quality of life in elderly patients with lumbar degenerative disease (LDD) treated with TLIF (transforaminal lumbar interbody fusion) combined with either unilateral pedicle screw fixation (UPSF) or bilateral pedicle screw fixation (BPSF).

Methods: A total of 112 patients with single- or double-segment lumbar degenerative disease were divided into two groups. In the unilateral fixation cohort, 32 single-segment patients and 22 double-segment patients underwent TLIF combined with UPSF, whereas in the bilateral fixation cohort, 34 single-segment patients and 24 double-segment patients underwent TLIF combined with BPSF. Data on operative time, intraoperative blood loss, time to postoperative ambulation, length of hospital stay, and perioperative complications were collected and analysed. Pain and functional status were preoperatively evaluated, in addition to being postoperatively evaluated at 1, 6, and 12 months, using the visual analogue scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, and Short Form-36 (SF-36) health survey questionnaire. Imaging follow-up was conducted for 1 year; at the final follow-up, the fusion rate was determined using the Bridwell fusion grading system, and clinical outcomes were assessed by using the modified MacNab criteria.

Results: All of the follow-up patients successfully completed the surgeries. There were no significant differences observed in average postoperative ambulation time or hospital stay between the UPSF and BPSF groups for either single- or double-segment patients. However, the UPSF group exhibited less average blood loss and a shorter surgery time (P < 0.05). At 12 months after surgery, there were no statistically significant differences observed in the VAS, ODI, or JOA scores between the UPSF and BPSF groups, although both scores were significantly improved compared with the preoperative scores. There were fewer perioperative complications observed in the UPSF group than in the BPSF group for both single-segment (P = 0.040) and double-segment (P = 0.009) patients. In terms of quality of life, the UPSF group exhibited better long-term physical and mental health outcomes compared with the BPSF group (single-segment PCS: preoperative, P = 0.694; 1 month, P = 0.310; 6 months, P = 0.022; 12 months, P = 0.020; MCS: preoperative, P = 0.849; 1 month, P = 0.655; 6 months, P = 0.022; 12 months, P < 0.001; double-segment PCS: preoperative, p = 0.890; 1 month, P = 0.374; 6 months, P = 0.022; 12 months, P = 0.023; MCS: preoperative, P = 0.447; 1 month, P = 0.419; 6 months, P = 0.023; 12 months, P < 0.001). At the final follow-up, there were no significant differences observed in fusion rates between the groups according to the Bridwell fusion grading system (P > 0.05), with both groups achieving satisfactory fusion rates. The modified MacNab criteria revealed that excellent and good results in each group were > 90%, with no significant differences being observed between the groups (P > 0.05).

Conclusions: For the treatment of LDD in elderly patients, both TLIF combined with UPSF and TLIF combined with BPSF can achieve favourable outcomes. However, UPSF demonstrates advantages compared with BPSF, including a shorter surgery time, reduced intraoperative blood loss, and greater postoperative quality of life.

Keywords: Bilateral pedicle screw fixation; Clinical efficacy; Elderly; Lumbar degenerative diseases; Quality of life; TLIF; Unilateral pedicle screw fixation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was performed in line with the principles of the Declaration of Helsinki. The methodology and ethics were reviewed and approved of by the institutional review board of Zunyi Medical University. written informed consent was obtained from all the participants prior to the enrollment of this study. Consent for publication: Written informed consent for publication was obtained from the participant. Competing interests: The authors declare no competing interests.

Figures

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Flowchart
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VAS scores for single-segment patients
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VAS scores for double-segment patients
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ODI scores for single-segment patients
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ODI scores for double-segment patients
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JOA scores for single-segment patients
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JOA scores for double-segment patients
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PCS and MCS scores for single-segment patients
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PCS and MCS scores for double-segment patients
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Typical case study
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