POSTERIOR UNILATERAL PEDICLE SCREW FIXATION PLUS LUMBAR INTERBODY FUSION FOR TREATMENT OF DEGENERATIVE LUMBAR INSTABILITY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WEI Fuxin , LIU Shaoyu , CUI Shangbin , WANG Le , LIANG Chunxiang , LONG Houqing , HUANG Yangliang.

Department of Spinal Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou Guangdong, 510700, P.R.China. Corresponding author: LIU Shaoyu, E-mail: gzsyliu@tom.com;

Corresponding author：

Keywords：

Degenerative lumbar instability; Posterior lumbar interbody fusion; Pedicle screw; Internal fixation

DOI：

10.7507/1002-1892.20130155

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Objective To evaluate the effectiveness of posterior unilateral pedicle screw fixation plus lumbar interbody fusion in treatment of degenerative lumbar instability. Methods Between February 2008 and December 2011, 33 patients with degenerative lumbar instability were treated with posterior unilateral pedicle screw fixation plus lumbar interbody fusion, including 14 cases of lumbar disc protrusion with instability, 15 cases of lumbar spinal stenosis with instability, 3 recurrent cases of lumbar disc protrusion at 1 year after discectomy, and 1 case of extreme lateral lumbar disc protrusion. There were 20 males and 13 females with an average age of 47.2 years (range, 39-75 years). The average disease duration was 12.8 months (range, 6-25 months). Single-segment-fixation was performed in 28 cases (L4, 5 in 21 cases, L5, S1 in 6 cases, and L5, 6 in 1 case), and double-segment-fixation was performed in 5 cases (L3, 4 and L4, 5). The clinical results were evaluated by using Oswestry disability index (ODI) and modified Japanese Orthopaedic Association (JOA) score for low back pain. Results Infection occurred in 1 case, and was cured after dressing change; primary healing was obtained in the other patients. Thirty-one patients were followed up 32.3 months on average (range, 15-53 months). Cage displacement occurred in 1 case who received bilateral pedicle screw fixation plus lumbar interbody fusion; no screw breaking, Cage displacement, or pseudoarthrosis was observed in the others. X-ray films showed bone fusion in the other patients except 1 case of bone fusion failure. ODI and JOA score at last follow-up were significantly improved when compared with the ones before operation and at 2 weeks after operation (P lt; 0.05); the improvement rates were 74.0% ± 10.1% and 83.6% ± 9.4%, respectively. Conclusion Posterior unilateral pedicle screw fixation plus lumbar interbody fusion is an effective and reliable method for patients with degenerative lumbar instability because it has the advantages of simple operation and less trauma.

Citation： WEI Fuxin,LIU Shaoyu,CUI Shangbin,WANG Le,LIANG Chunxiang,LONG Houqing,HUANG Yangliang.. POSTERIOR UNILATERAL PEDICLE SCREW FIXATION PLUS LUMBAR INTERBODY FUSION FOR TREATMENT OF DEGENERATIVE LUMBAR INSTABILITY. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(6): 703-707. doi: 10.7507/1002-1892.20130155 Copy

1.	朱云荣, 叶晓健, 蒋玉权, 等. 改良腰椎后路椎间植骨单侧椎弓根螺钉固定在腰椎融合手术中的应用. 第二军医大学学报, 2010, 31(10): 1095-1099.
2.	王生介, 厉晓龙, 夏才伟, 等. 髓核摘除单侧内固定椎间融合术治疗腰椎间盘突出症早期疗效. 中国脊柱脊髓杂志, 2011, 21(7): 583-587.
3.	Kabins MB, Weintein JN, Spratt KF, et al. Isolated L4-L5 fusions using the variable screw placement system: unilateral versus bilateral. Spine (Phila Pa 1976), 1992, 5(1): 39-49.
4.	Deutsch H, Musacchio MJ Jr. Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation. Neurosurg Focus, 2006, 20(3): E10.
5.	Beringer WF, Mobasser JP. Unilateral pedicle screw instrumentation for minimally invasive transforaminal lumbar interbody fusion. Neurosurg Focus, 2006, 20(3): E4.
6.	Tuttle J, Shakir A, Choudhri HF. Paramedian approach for transforaminal lumbar interbody fusion with unilateral pedicle screw fixation technical note and preliminary report on 47 cases. Neurosurg Focus, 2006, 20(3): E5.
7.	Cloward R. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. J Neurosurg, 1953, 10(2): 154-168.
8.	Ozdemir HM, Us AK, Oğün T. The role of anterior spinal instrumentation and allograft fibula for the treatment of pott disease. Spine (Phila Pa 1976), 2003, 28(5): 474-479.
9.	Miekisiak G, Kollataj M, Dobrogowski J, et al. Validation and cross-cultural adaptation of the Polish version of the Oswestry Disability Index. Spine (Phila Pa 1976), 2013, 38(4): E237-E243.
10.	孙兵, 车晓明. 日本骨科协会评估治疗(JOA评分). 中华神经外科杂志, 2012, 28(6): 623.
11.	McAfee PC, Farey ID, Sutterlin CE, et al. The effects of spinal implant rigidity on vertebral bone density. A canine model. Spine (Phila Pa 1976), 1991, 16(6 Suppl): S190-197.
12.	Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976), 2005, 30(1): 123-129.
13.	Harms T, Rolinger H. A one-stage procedure in operative treatment of spondylolietheses: dorsal traction-reposition and anterior fusion. Z Orthop Ihre Grenzgeb, 1982, 120(3): 343-347.
14.	陈家麟, 茅祖斌, 吴小涛. 四种经椎间孔腰椎间融合固定方式的三维有限元分析. 中国组织工程研究与临床康复, 2008, 12(39): 7605-7609.
15.	Chang TS, Chang JH, Wang CS, et al. Evaluation of unilateral cage-instrumented fixation for lumbar spine. J Orthop Surg Res, 2010, 5: 86.
16.	Goel VK, Lim TH, Gwon J, et al. Effects of rigidity of an internal fixation device A. comprehensive biomechanical investigation. Spine (Phila Pa 1976), 1991, 16(3 Suppl): S155-161.
17.	杨群, 吕德成, 姜长明, 等. 单枚 cage 单侧椎弓根螺钉内固定术治疗退行性腰椎不稳. 中国脊柱脊髓杂志, 2009, 19(12): 909-911.
18.	Xie Y, Ma H, Li H, et al. Comparative study of unilateral and bilateral pedicle screw fixation in posterior lumbar interbody fusion. Orthopedics, 2012, 35(10): e1517-1523.
19.	Chen HH, Cheung HH, Wang WK, et al. Biomechanical analysis of unilateral fixation with interbody cages. Spine (Phila Pa 1976), 2005, 30(4): E92-96.
20.	Suk KS, Lee HM, Kim NH, et al. Unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion. Spine (Phila Pa 1976), 2000, 25(14): 1843-1847.

1. 朱云荣, 叶晓健, 蒋玉权, 等. 改良腰椎后路椎间植骨单侧椎弓根螺钉固定在腰椎融合手术中的应用. 第二军医大学学报, 2010, 31(10): 1095-1099.
2. 王生介, 厉晓龙, 夏才伟, 等. 髓核摘除单侧内固定椎间融合术治疗腰椎间盘突出症早期疗效. 中国脊柱脊髓杂志, 2011, 21(7): 583-587.
3. Kabins MB, Weintein JN, Spratt KF, et al. Isolated L4-L5 fusions using the variable screw placement system: unilateral versus bilateral. Spine (Phila Pa 1976), 1992, 5(1): 39-49.
4. Deutsch H, Musacchio MJ Jr. Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation. Neurosurg Focus, 2006, 20(3): E10.
5. Beringer WF, Mobasser JP. Unilateral pedicle screw instrumentation for minimally invasive transforaminal lumbar interbody fusion. Neurosurg Focus, 2006, 20(3): E4.
6. Tuttle J, Shakir A, Choudhri HF. Paramedian approach for transforaminal lumbar interbody fusion with unilateral pedicle screw fixation technical note and preliminary report on 47 cases. Neurosurg Focus, 2006, 20(3): E5.
7. Cloward R. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. J Neurosurg, 1953, 10(2): 154-168.
8. Ozdemir HM, Us AK, Oğün T. The role of anterior spinal instrumentation and allograft fibula for the treatment of pott disease. Spine (Phila Pa 1976), 2003, 28(5): 474-479.
9. Miekisiak G, Kollataj M, Dobrogowski J, et al. Validation and cross-cultural adaptation of the Polish version of the Oswestry Disability Index. Spine (Phila Pa 1976), 2013, 38(4): E237-E243.
10. 孙兵, 车晓明. 日本骨科协会评估治疗(JOA评分). 中华神经外科杂志, 2012, 28(6): 623.
11. McAfee PC, Farey ID, Sutterlin CE, et al. The effects of spinal implant rigidity on vertebral bone density. A canine model. Spine (Phila Pa 1976), 1991, 16(6 Suppl): S190-197.
12. Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976), 2005, 30(1): 123-129.
13. Harms T, Rolinger H. A one-stage procedure in operative treatment of spondylolietheses: dorsal traction-reposition and anterior fusion. Z Orthop Ihre Grenzgeb, 1982, 120(3): 343-347.
14. 陈家麟, 茅祖斌, 吴小涛. 四种经椎间孔腰椎间融合固定方式的三维有限元分析. 中国组织工程研究与临床康复, 2008, 12(39): 7605-7609.
15. Chang TS, Chang JH, Wang CS, et al. Evaluation of unilateral cage-instrumented fixation for lumbar spine. J Orthop Surg Res, 2010, 5: 86.
16. Goel VK, Lim TH, Gwon J, et al. Effects of rigidity of an internal fixation device A. comprehensive biomechanical investigation. Spine (Phila Pa 1976), 1991, 16(3 Suppl): S155-161.
17. 杨群, 吕德成, 姜长明, 等. 单枚 cage 单侧椎弓根螺钉内固定术治疗退行性腰椎不稳. 中国脊柱脊髓杂志, 2009, 19(12): 909-911.
18. Xie Y, Ma H, Li H, et al. Comparative study of unilateral and bilateral pedicle screw fixation in posterior lumbar interbody fusion. Orthopedics, 2012, 35(10): e1517-1523.
19. Chen HH, Cheung HH, Wang WK, et al. Biomechanical analysis of unilateral fixation with interbody cages. Spine (Phila Pa 1976), 2005, 30(4): E92-96.
20. Suk KS, Lee HM, Kim NH, et al. Unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion. Spine (Phila Pa 1976), 2000, 25(14): 1843-1847.

Chinese Journal of Reparative and Reconstructive Surgery

POSTERIOR UNILATERAL PEDICLE SCREW FIXATION PLUS LUMBAR INTERBODY FUSION FOR TREATMENT OF DEGENERATIVE LUMBAR INSTABILITY

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