Comparison of the efficacies of large channel full-endoscopic intervertebral decompression and fusion with unilateral and bilateral pedicle screw fixations for lumbar degenerative diseases

English Keywords:Lumbar degenerative diseases  Decompression fusion and internal fixation  Pedicle screw fixation  Unilateral/bilateral  Large channel full-endoscopic technique

English Abstract:

  【Abstract】 Objectives: To compare the clinical efficacies of large channel full-endoscopic intervertebral decompression and fusion with unilateral pedicle screw fixation and bilateral pedicle screw fixation in the treatment of single-segment lumbar degenerative diseases(LDD). Methods: The clinical data of 47 patients with single-segment LDD treated with intervertebral decompression, fusion and internal fixation in our hospital from December 2019 to October 2021 were retrospectively analyzed. Among the patients, 20 received unilateral pedicle screw fixation(unilateral fixation group), including 5 males and 15 females, aged 39-69 years(54.1±9.6 years); The other 27 were treated with bilateral pedicle screw fixation(bilateral fixation group), including 9 males and 18 females, aged 40-70 years(57.8±9.4 years). There were no statistical differences between the two groups in terms of age, body mass index(BMI), gender, follow-up time, operative segment, and type of diseases(P>0.05). The operative time, number of intraoperative fluoroscopies, hospitalization expenses, length of hospital stay, pre- and post-operative hemoglobin values and changes, and complications were compared between the two groups; The low back and leg pains were evaluated with visual analog scale(VAS) before operation and at 3d, 3 months and 1 year after operation and function disabilites were assessed with Oswestry disability index(ODI) at 3 months and 1 year after operation. The intervertebral fusion was evaluated with CT at 1 year after surgery and the clinical outcomes were assessed by the modified MacNab criteria. Results: The patients were followed up for 1 year and above. The operative time, number of intraoperative fluoroscopies, hospitalization expenses, and length of hospital stay were significantly higher in the bilateral fixation group than those in the unilateral fixation group(P<0.05), while no statistically significant difference was found in the pre- and post-operative hemoglobin values and changess between the two groups(P>0.05). The VAS scores at 3d, 3 months and 1 year postoperatively and ODI at 3 months and 1 year postoperatively were significantly lower in both groups than before surgery(P<0.05), while no statistical difference was found between the two groups in VAS scores and ODI at the same postoperative time points, respectively(P>0.05). The unilateral fixation group was not statistically different from the bilateral fixation group in the incidence of complications(10.0% vs 11.1%), fusion rate(90.0% vs 92.6%) and modified MacNab excellent and good rate(90.0% vs 88.9%) at 1 year after surgery(P>0.05). Conclusions: Large channel full-endoscopic intervertebral decompression and fusion with unilateral pedicle screw fixation and bilateral pedicle screw fixation are both safe and effective in the treatment of single-segment LDD, and unilateral fixation is superior in the number of intraoperative fluoroscopies, hospitalization expenses, operative time, and length of hospital stay.