Unilateral pedicle screw fixation and lumbar interbody fusion under the Quadrant tunnel for the treatment of prolapsed lumbar disc herniation in young patients / 中国骨伤

OBJECTIVE@#To explore the clinical effect of unilateral screw fixation and lumbar interbody fusion under the Quadrant tunnel to treat prolapsed lumbar disc herniation in young patients.@*METHODS@#Between January 2015 and January 2017, 18 young patients with prolapsed lumbar disc herniation were treated with unilateral pedicle screw fixation and lumbar interbody fusion under Quadrant tunnel. Among them, there were 10 males and 8 females, aged from 20 to 28 years old with an average of 22.5 years. The VAS, lumbar JOA scores were compared before sutgery, 1 and 3 months after surgery and at the final follow-up. The improvement of clinical symptoms and bone fusion rate were evaluated according to the improved rate of JOA score and X-rays data at the final follow-up.@*RESULTS@#All 18 patients were followed up from 14 to 34 months with an average of 24.3 months. All incisions got primary healing, and no nerve root injury, screw loose or rupture, threaded fusion cage sink or other complications were found. The postoperative VAS, lumbar JOA scores were improved significantly(<0.05). Neurologic function improved significantly in the final follow-up. The postoperative JOA improvement rate was excellent in 10 cases, good in 6 cases, and fair in 2 cases. Postoperative bone graft fusion rate was 100% at 3 to 6 months.@*CONCLUSIONS@#Unilateral screw fixation and lumbar interbody fusion under the Quadrant tunnel is an effective and safe method in treating prolapsed lumbar disc herniation for young patients, it has advantage of short operation time, small trauma and short hospitalization time. However, the indications should be well considered.

The mid-and long-term clinical and radiological outcomes of unilateral instrumented transforaminal lumbar interbody fusion with bilateral decompression via unilateral paramedian incision / 复旦学报（医学版）

Objective A retrospective study to determine the mid-and long-term clinical and radiological outcomes of unilateral instrumented transforaminal lumbar interbody fusion (TLIF) with bilateral decompression via unilateral paramedian incision.Methods From J ul.,2007 to J un.,2010,73 patients with single segmental lumbar stenosis were collected in this study.All of 73 patients had bilateral signs and symptoms of stenosis,and accepted the unilateral TLIF with bilateral decompression via unilateral paramedian incision.The oswestry disability index (ODI),Japanese orthopedic association scale (JOA),visual analog scale (VAS),angle of lumbar lordosis (LL) and angle of segmental lordosis (SL) were calculated and compared at pre-operation,six months after operation and last follow up.In addition,the operating time,blood loss,length of hospital stay,complications and fusion rate were also recorded.Results There were 30 males and 43 females in this study.The mean age,mean operation time,mean blood loss and mean length of hospital stay was (57.7 ± 10.1) years,(92.0 ± 26.7)minutes,(150.5 ± 130.3) mL and (12.3 ± 2.7) days,respectively.The follow up was 5 years at least and the mean follow up was (79.4 ± 11.1) months.The ODI,JOA and VAS at six months after operation and last follow up were significantly better than those at pre-operation.As for the sagittal alignment assessment,the LL and SL at six months after operation and last follow up also increased significantly compared with those at pre-operation.All of 73 patients achieved solid interbody fusion.Conclusions Unilateral instrumented TLIF with bilateral decompression via unilateral paramedian incision is an effective innovation.Compared with the traditional TLIF,it could not only reduced the surgical injury and operation cost but also achieve the same ideal effect.

Effect evaluation of over 5 year follow up of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion for lumbar degenerative diseases / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of over 5 year follow up of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion(TLIF) in treating lumbar degenerative diseases.</p><p><b>METHODS</b>The clinical data of 24 patients with lumbar degenerative disease underwent unilateral pedicle screw fixation with transforaminal lumbar interbody fusion from March 2007 to October 2009, were retrospectively analyzed. There were 13 males and 11 females, aged from 34 to 68 years old with an average of 52 years. Postoperative pain and functional results were analyzed by the visual analogue scale(VAS) and Oswestry Disability Index(ODI). Radiological examination was obtained for each patient to assess the height of intervertebral space, postoperative intervertebral fusion conditions and general complications.</p><p><b>RESULTS</b>All patients were followed up from 5 to 8 years with an average of 6.7 years. VAS scores of low back pain and leg pain decreased from preoperative 7.82±0.71, 8.42±1.24 to postoperative 1.87±0.81, 2.23±1.62, respectively(<0.05). ODI decreased from preoperative(53.42±8.26)% to postoperative(12.45±7.67)%(<0.05). Postoperative intervertebral space height in different segments were improved than preoperative(<0.05), but in final follow up it was decreased than 3 months after operation(<0.05). There was no significant difference in the postoperative intervertebral space height between the operated side and non operated side. But at final follow up, the intervertebral space height of non operated side was obviously loss. At final follow up, the fusion rate was 95.8%. The incidence of adjacent segment degeneration was 45.8%. The paraspinal muscle fibrosis incidence was 8.3%. No complications such as secondary scoliosis, intervertebral height loss, cage slippage, screw loosening and internal fixation breakage were found.</p><p><b>CONCLUSIONS</b>Unilateral pedicle screw fixation with TLIF is a satisfactory method and can obtain good effects in treating lumbar degenerative diseases according to over 5 year follow up, however, its indications should be well considered. But the problems such as intervertebral space height of operated side loss and adjacent segment degeneration after unilateral pedicle screw fixation need further clinical study.</p>

Biomechanical Analysis of Fusion Segment Rigidity Upon Stress at Both the Fusion and Adjacent Segments: A Comparison between Unilateral and Bilateral Pedicle Screw Fixation

PURPOSE: The purpose of this study was to investigate the effects of unilateral pedicle screw fixation on the fusion segment and the superior adjacent segment after one segment lumbar fusion using validated finite element models. MATERIALS AND METHODS: Four L3-4 fusion models were simulated according to the extent of decompression and the method of pedicle screws fixation in L3-4 lumbar fusion. These models included hemi-laminectomy with bilateral pedicle screw fixation in the L3-4 segment (BF-HL model), total laminectomy with bilateral pedicle screw fixation (BF-TL model), hemi-laminectomy with unilateral pedicle screw fixation (UF-HL model), and total laminectomy with unilateral pedicle screw fixation (UF-TL model). In each scenario, intradiscal pressures, annulus stress, and range of motion at the L2-3 and L3-4 segments were analyzed under flexion, extension, lateral bending, and torsional moments. RESULTS: Under four pure moments, the unilateral fixation leads to a reduction in increment of range of motion at the adjacent segment, but larger motions were noted at the fusion segment (L3-4) in the unilateral fixation (UF-HL and UF-TL) models when compared to bilateral fixation. The maximal von Mises stress showed similar patterns to range of motion at both superior adjacent L2-3 segments and fusion segment. CONCLUSION: The current study suggests that unilateral pedicle screw fixation seems to be unable to afford sufficient biomechanical stability in case of bilateral total laminectomy. Conversely, in the case of hemi-laminectomy, unilateral fixation could be an alternative option, which also has potential benefit to reduce the stress of the adjacent segment.

Clinical study of unilateral transforaminal lumbar interbody fusion with unilateral pedicle screw fixation for the treatment of lumbar degenerative diseases / 中国矫形外科杂志

0.05). Incision size,operating time,blood loss,hospital stay,medical device expenses,postoperative VAS and ODI,clinical outcomes,fusion rates,and complication rates were studied and tested with independent sample t test and x2 test.[Results]The mean follow-up was 19.1 months (range,12~25 months) in group A and 24.6 months (range,9~36 months) in group B.There were statistically significant differences in the incision size,operating time,blood loss,hospital stay and medical device expenses (P0.05).[Conclusion]Unilateral transforaminal lumbar interbody fusion with unilateral pedicle screw fixation has the advantages of small incision,little bleeding,no destruction of the contralateral structure,short operating time or hospital stay,low medical device expenses and good recovery.But the operation indications must be strictly defined.

Unilateral vesus bilateral minimally invasive transforaminal fixation in lumbar interbody fusion / 中国矫形外科杂志

0.05).Operation time in group A was shorter than that in group B,with significant difference(P0.05).No postoperative complication was found in two groups.[Conclusion]Unilateral TLIE technique has achieved satisfying postoperative effect compared with bilateral TLIF,with a good prospect in clinical application.