单侧、双侧内固定联合经椎间孔椎间融合对腰椎术后假关节形成及腰椎活动的影响

目的:探讨后路单侧、双侧内固定联合经椎间孔椎间融合术(TLIF)治疗单节段腰椎退行性病变术后假关节的发生及其对腰椎活动的影响。方法:回顾性队列研究。纳入2009年1月—2015年5月徐州市中心医院121例腰椎退行性病变患者的临床资料，其中男45例、女76例，年龄40~70(50.8±6.8)岁。根据手术方式的不同分为两...

Comparison of the incidence of pseudarthrosis and its effects on lumbar motion after unilateral versus bilateral pedicle screw fixation with transforaminal lumbar interbody fusion in degenerative lumbar diseases

Objective To evaluate the incidence of pseudarthrosis and its effects on lumbar motion after unilateral versus bilateral pedicle screw fixation with transforaminal lumbar interbody fusion (TLIF) in degenerative lumbar diseases. Methods A retrospective cohort study was conducted among 121 patients with single-segment degenerative lumbar disease treated with unilateral or bilateral pedicle screw fixation combined with TLIF. The patients were divided into the unilateral (n=48) and bilateral groups (n=73). Ranges of motion (ROM) in the fixed segment (L_4/5), upper adjacent segment (L_3/4), lower adjacent segment (L₅/S₁), and full lumbar segment were measured based on flexion-extension films. Visual analog scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate clinical efficacy, and computed tomography was used to assess interbody fusion. This study compared: (1) the baseline data, the number of cases with pseudarthrosis after surgery, and the number of cases requiring revision due to pseudarthrosis between the two groups; (2) the clinical efficacy before operation and at the final follow-up between the two groups; (3) the imaging parameters, VAS score, and ODI score before surgery and at the last follow-up among the cases of the two groups without pseudarthrosis and among the cases in the unilateral group with and without pseudarthrosis.Results No significant difference in clinical baseline data was found between the two groups(all P values＞0.05). The unilateral group had a pseudarthrosis incidence of 18.6% (9/48) and a pseudarthrosis revision rate of 12.5% (6/48), which were higher than those in the bilateral group (5.5% 4/73] and 1.4% 1/73], respectively). The differences were statistically significant (χ²=4.024, 4.698; all P values＜0.05). No significant differences in VAS and ODI scores were found between the two groups before surgery and at the final follow-up (all P values＞0.05). No significant differences were found in the ROMs of L_4/5, L_3/4, L₅S₁, and the whole lumbar segment, as well as in the VAS and ODI scores, before surgery and at the final follow-up among the cases without pseudarthrosis between the two groups (all P values＞0.05). In the unilateral group, the VAS score, and ODI score in the cases with pseudarthroses were higher than those in the cases without pseudarthroses at the final follow-up; the L_3/4 ROM in the cases with pseudarthroses were lower than that in the cases without pseudarthroses (all P values＜0.05); L_4/5 ROM was 5.67°±1.12° in the case with pseudarthroses, and 0° in the cases without pseudarthroses at the final follow-up. There was no significant difference between the whole lumbar segment ROM and L₅/S₁ ROM before surgery and at the last follow-up(all P values＞0.05).Conclusions Unilateral and bilateral pedicle screw fixation with TLIF can achieve the same medium-term clinical results. However, unilateral pedicle screw fixation has relatively lower fusion segment stability, which results in higher pseudarthrosis incidence and thus affects lumbar movement pattern. Therefore, bilateral pedicle screw fixation combined with TLIF is a biomechanically superior surgical approach.