Single-cage and single cage plus unilateral pedicle screw fixation for lumbar disc herniation complicated with lumbar instability

English Keywords:Disc herniation  Lumbar instability syndrome  Pedicle screw  Interbody cage  Unilateral fixation

English Abstract:

  【Abstract】 Objective：To investigate the surgical outcome of single-cage and single cage plus unilateral pedicle screw fixation after decompression for lumbar disc herniation complicated with lumbar instability.Method：From January 2006 to January 2008，62 cases of lumbar disc herniation complicated with lumbar instability were reviewed retrospectively.28 cases underwent a single cage placement after decompression（group A），while 34 cases experienced single cage plus unilateral pedicle screw placement（group B）.JOA 15 score system were used to evaluate the neurological function（subjective and objective symptom，bladder function） and the excellent rate and improve rate as well as fusion status and cage-related complication were reviewed retrospectively.Result：Preoperative JOA score between two groups showed no significant difference（P＞0.05），after an average of 24 months follow-up（range，12-30 months），JOA score between two groups at final follow-up showed remarkable difference（P<0.05），however which had significant difference compared with preoperative counterparts（P<0.01）.The improve rate for group A and B was 78.12% and 94.32%，excellent to good rate was 82.14% and 97.06%，bony union rate was 78.57% and 97.06% respectively.Significant difference with respect to improve rate，excellent to good rate and bony union rate between two groups（P<0.05）.6 of 28 cases（21.43%） in group A were noted cage related complications（cage prolapsed，displacement and subsidence），while 1 of 34 cases（2.94%） in group B had such complications，which showed significant difference（P<0.05）.Conclusion：Single-cage and single cage plus unilateral pedicle screw fixation are both optional for lumbar disc herniation complicated with lumbar instability，however the latter has superior outcome than the former due to higher bony union rate and less instrument related complication.