Unilateral versus bilateral pedicle screw fixation in lateral lumbar interbody fusion in the treatment of lumbar degenerative diseases

English Keywords:Lumbar degenerative disease  Lateral approach  Lumbar interbody fusion  Clinical effect

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical efficacy of single-level lateral lumbar interbody fusion(LLIF) combined with unilateral pedicle screw(UPS) versus bilateral pedicle screw(BPS) fixation in the treatment of lumbar degenerative disease(LDD). Methods: A retrospective analysis was conducted on 65 patients with LDD who underwent single-level LLIF between January 2019 and December 2021. 14 patients received UPS fixation(UPS group) and 51 received BPS fixation(BPS group). The operative time, hospitalization cost, and imaging parameters including disc height(DH), foraminal height(FH), lumbar lordosis(LL), segmental lordosis(SL), axial central canal cross-sectional area(CCA), midsagittal canal diameter(CD), ligamentum flavum area(LFA), and ligamentum flavum thickness(LFT), as well as fusion rate, complication rate, and clinical outcomes were compared between the two groups. Results: The UPS group was shorter in operative time(80.64±10.87min vs 131.57±11.37min) and lower in hospitalization cost(86463.14±1889.54 yuan vs 101213.06±4512.54 yuan) compared with the BPS group(P<0.05). Both groups showed significant improvements in DH, FH, SL, CD, and CCA after operation, with no significant differences between groups(P>0.05). The immediate postoperative thickness of the right ligamentum flavum was significantly lower in the UPS group(2.28±0.71mm vs 2.67±0.49mm, P=0.019). The fusion rates were 85.7% in the UPS group and 94.1% in the BPS group, with no statistically significant difference(P=0.292). There was no significant difference in complication rates between the two groups(28.6％ vs 23.5%, P=0.733). Conclusions: Single-level LLIF combined with UPS fixation for treating LDD provides comparable imaging improvements, clinical outcomes, and complications control to BPS fixation, while offering the advantages of reduced operative time and lower hospitalization costs, supporting its clinical feasibility.