CLINICAL APPLICATION OF UNILATERAL PEDICLE SCREW FOR LUMBAR INTERVERTEBRAL DISC PROTRUSION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZENGJin , YAOHaoqun ,  DAIMin , ZHANGBin , LEIGanggang , ZHANGZhihong , LIUHucheng , LIWeiping

Department of Orthopaedics, the First Affiliated Hospital of Nanchang University, Nanchang Jiangxi, 330006, P. R. China;

Corresponding author：

DAIMin, Email: daimin@medmail.com

Keywords：

Lumbar intervertebral disc protrusion; Interbody fusion; Unilateral implantation; Pedicle screw rod

DOI：

10.7507/1002-1892.20140017

Video：

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Objective To explore the feasibility and effectiveness of unilateral pedicle screw rod and single poly (ether-ether-ketone) (PEEK) Cage for lumbar intervertebral disc protrusion. Methods A total of 126 cases of single segment of lumbar intervertebral disc protrusion between January 2006 and June 2012 were divided into 2 groups in the randomized clinical trial. Unilateral pedicle screw fixation and single PEEK Cage was used in 63 cases (research group), and bilateral pedicle screw fixation and single PEEK Cage in 63 cases (control group). There was no significant difference in gender, age, disease duration, side, and affected segment between 2 groups (P>0.05). Schulte evaluation criterion was used to assess bone graft fusion, Oswestry disability index (ODI) to estimate the quality of life situation, and visual analogue scale (VAS) to evaluate the improvements of lower back pain. Macnab standards was applied to assess postoperative effectiveness, and Emery ways to measure the height of intervertebral space. Results The incision length, operation time, intraoperative blood loss, hospitalization time, and hospitalization fee in research group were significantly less than those in control group (P<0.05). The patients were followed up 12-79 months (mean, 21.3 months) in research group, and 15-73 months (mean, 22.6 months) in control group. The postoperative lordosis was recovered well, and the height of intervertebral space was increased. No loosening or breakage of internal fixation occurred. The time of bone graft fusion was (6.8±1.3) months in research group and was (7.1±1.2) months in control group, showing no significant difference (t=1.153, P=0.110). The height of intervertebral space, ODI score, and VAS score were significantly improved when compared with preoperative ones in 2 groups (P<0.05), but no significant difference was found between 2 groups at preoperation and last follow-up (P>0.05). At 3 months after operation, postoperative effectiveness was assessed according to Macnab criterion, the excellent and good rate was 95.23% in research group (excellent in 13 cases, good in 47 cases, and fair in 3 cases) and was 71.42% in control group (excellent in 7 cases, good in 38 cases, fair in 15 cases, and poor in 3 cases); the research group was significantly superior to control group (χ₂=6.110, P=0.006). Conclusion Unilateral pedicle screw fixation and single PEEK Cage has the advantages of small trauma, reliable fixation, shorter operation time, less bleeding, less economic cost, and early off-bed activity time. It can provide a simple and reliable choice in single segmental lumbar intervertebral disc protrusion.

Citation： ZENGJin, YAOHaoqun, DAIMin, ZHANGBin, LEIGanggang, ZHANGZhihong, LIUHucheng, LIWeiping. CLINICAL APPLICATION OF UNILATERAL PEDICLE SCREW FOR LUMBAR INTERVERTEBRAL DISC PROTRUSION. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(1): 74-78. doi: 10.7507/1002-1892.20140017 Copy

1.	Iquchi T,Kanemura A,Kasahara K,et al.Lumbar instability and clinical symptoms:which is the more critical factor for symptoms:sagittal translation orsegment angulation? J Spinal Disord Tech,2004,17(4):284-290.
2.	鲁玉来.腰椎间盘突出症.中国矫形外科杂志,2004,12(24):1901-1904.
3.	Eie N.Comparison of the results in patients operated upon for ruptured lumbar discs with and without spinal fusion.Acta Neurochir,1978,41(1-3):107-113.
4.	DiPaola CP,Molimari RW.Posterior lumbar interbody fusion.J Am Acad Orthop Surg,2008,16(3):130-139.
5.	Lee JK,Kim KW.Bone mineral densities of the vertebral body and intertransverse fusion mass after instrumented intertransverseprocess fusion.Spine (Phila Pa 1976),2010,35(21):E1106-1110.
6.	Park P,Garton HJ,Gala VC,et al.Adjacent segment disease after lumbar or lumbosacral fusion:review of the literature.Spine (Phila Pa 1976),2004,29(17):1938-1944.
7.	Yone K,Sakou T,Kawauchi Y,et al.Indication of fusion for lumbar spinal stenosis in elderly patients and its significance.Spine (Phila Pa 1976),1996,21(2):242-248.
8.	Rihn JA.Commentary:is bilateral pedicle screw fixation necessary when performing a transforaminal lumbar interbody fusion? An analysis of clinical outcomes,radiographic outcomes,and cost.Spine J,2012,12(3):216-217.
9.	Kabins MB,Weinstein JN,Spratt KF,et al.Isolated L4-L5 fusions using the variable screw placement system:unilateral versus bilateral.J Spinal Disord,1992,5(1):39-49.
10.	Schulte TL,Leistra F,Bullmann V,et al.Disc height reduction in adjacent segments and clinical outcome 10 years after lumbar 360 degrees fusion.Eur Spine J,2007,16(12):2152-2158.
11.	Macnab I.Negative disc exploration.An analysis of the causes of nerve-root involvement in sixty-eight patients.J Bone Joint Surg (Am),1971,53(5):891-903.
12.	Chen SH,Lim SC,Tsia WC,et al.Biomechanical comparison of unilateral and bilateral pedicle screws fixation for transforaminal lumbar interbodyfusion after decompressive surgery-a finite element analysis.BMC Musculoskelet Disord,2012,13:72.
13.	Shah RR,Mohammed S,Saifuddin A,et al.Radiologic evaluation of adjacent superior segment facet joint violation following transpedicular instrumentation of the lumbar spine.Spine (Phila Pa 1976),2003,28(3):272-275.
14.	Rahman M,Summers LE,Richter B,et al.Comparison of techniques for decompressive lumbar laminectomy:the minimally invasive versus the"classic"open approach.Minim Invasive Neurosurg,2008,51(2):100-105.
15.	Iwatsuki K,Yoshimine T,Aoki M.Bilateral interlaminar fenestration and unroofing for the decompression of nerve roots by using a unilateralapproach in lumbar canal stenosis.Surg Neurol,2007,68(5):487-492.
16.	Kotil K,Ali Akçetin M,Savaş Y.Clinical and radiologic outcomes of TLIF applications with or without pedicle screw:a double center prospectivepilot comparative study.J Spinal Disord Tech,2013,26(7):359-366.
17.	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.
18.	Sonmez E,Cower I,Sahinturk F,et al.Unilateral percutaneous pedicle screw instrumentation with minimally invasive TLIF for the treatment of recurrentlumbar disk disease:2 years follow-up.Turk Neurosurg,2013,23(3):372-378.
19.	Raynor B,Pugh J,Shapiro I.Cervical facetectomy and its effect on spine strength.J Neurosurg,1985,63(2):278-282.
20.	Chen HH,Cheung NN,Wang WK,et al.Biomechanical analysis of unilateral fixation with interbody cages.Spine (Phila Pa 1976),2005,30(4):E92-96.

1. Iquchi T,Kanemura A,Kasahara K,et al.Lumbar instability and clinical symptoms:which is the more critical factor for symptoms:sagittal translation orsegment angulation? J Spinal Disord Tech,2004,17(4):284-290.
2. 鲁玉来.腰椎间盘突出症.中国矫形外科杂志,2004,12(24):1901-1904.
3. Eie N.Comparison of the results in patients operated upon for ruptured lumbar discs with and without spinal fusion.Acta Neurochir,1978,41(1-3):107-113.
4. DiPaola CP,Molimari RW.Posterior lumbar interbody fusion.J Am Acad Orthop Surg,2008,16(3):130-139.
5. Lee JK,Kim KW.Bone mineral densities of the vertebral body and intertransverse fusion mass after instrumented intertransverseprocess fusion.Spine (Phila Pa 1976),2010,35(21):E1106-1110.
6. Park P,Garton HJ,Gala VC,et al.Adjacent segment disease after lumbar or lumbosacral fusion:review of the literature.Spine (Phila Pa 1976),2004,29(17):1938-1944.
7. Yone K,Sakou T,Kawauchi Y,et al.Indication of fusion for lumbar spinal stenosis in elderly patients and its significance.Spine (Phila Pa 1976),1996,21(2):242-248.
8. Rihn JA.Commentary:is bilateral pedicle screw fixation necessary when performing a transforaminal lumbar interbody fusion? An analysis of clinical outcomes,radiographic outcomes,and cost.Spine J,2012,12(3):216-217.
9. Kabins MB,Weinstein JN,Spratt KF,et al.Isolated L4-L5 fusions using the variable screw placement system:unilateral versus bilateral.J Spinal Disord,1992,5(1):39-49.
10. Schulte TL,Leistra F,Bullmann V,et al.Disc height reduction in adjacent segments and clinical outcome 10 years after lumbar 360 degrees fusion.Eur Spine J,2007,16(12):2152-2158.
11. Macnab I.Negative disc exploration.An analysis of the causes of nerve-root involvement in sixty-eight patients.J Bone Joint Surg (Am),1971,53(5):891-903.
12. Chen SH,Lim SC,Tsia WC,et al.Biomechanical comparison of unilateral and bilateral pedicle screws fixation for transforaminal lumbar interbodyfusion after decompressive surgery-a finite element analysis.BMC Musculoskelet Disord,2012,13:72.
13. Shah RR,Mohammed S,Saifuddin A,et al.Radiologic evaluation of adjacent superior segment facet joint violation following transpedicular instrumentation of the lumbar spine.Spine (Phila Pa 1976),2003,28(3):272-275.
14. Rahman M,Summers LE,Richter B,et al.Comparison of techniques for decompressive lumbar laminectomy:the minimally invasive versus the"classic"open approach.Minim Invasive Neurosurg,2008,51(2):100-105.
15. Iwatsuki K,Yoshimine T,Aoki M.Bilateral interlaminar fenestration and unroofing for the decompression of nerve roots by using a unilateralapproach in lumbar canal stenosis.Surg Neurol,2007,68(5):487-492.
16. Kotil K,Ali Akçetin M,Savaş Y.Clinical and radiologic outcomes of TLIF applications with or without pedicle screw:a double center prospectivepilot comparative study.J Spinal Disord Tech,2013,26(7):359-366.
17. 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.
18. Sonmez E,Cower I,Sahinturk F,et al.Unilateral percutaneous pedicle screw instrumentation with minimally invasive TLIF for the treatment of recurrentlumbar disk disease:2 years follow-up.Turk Neurosurg,2013,23(3):372-378.
19. Raynor B,Pugh J,Shapiro I.Cervical facetectomy and its effect on spine strength.J Neurosurg,1985,63(2):278-282.
20. Chen HH,Cheung NN,Wang WK,et al.Biomechanical analysis of unilateral fixation with interbody cages.Spine (Phila Pa 1976),2005,30(4):E92-96.

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