Use of unilateral screw-stick and cage bone graft fusion for the treatment of lumbar disc herniation

Authors

  • Zeng Jin Department Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Nanchang, Jiangxi, P.R
  • Fu Changlin Department Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Nanchang, Jiangxi, P.R
  • Yao Haoqun Department Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Nanchang, Jiangxi, P.R
  • Dai Min Department Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Nanchang, Jiangxi, P.R
  • Zhang Bin Department Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Nanchang, Jiangxi, P.R

Keywords:

Lumbar disc herniation, Interbody fusion, Unilateral implantation, Pedicle screw rod, Curative effect

Abstract

Background:The clinical application of unilateral pedicle screw internal fixation to the treatment of lumbar disc herniation is rarely reported. The aim of our study was to discuss the feasibility and clinical effects of using unilateral pedicle screw-stick and single polyether ether ketone (PEEK) Cage combined with unilateral pedicle internal fixation for lumbar disc herniation.

Methods:Retrospective analysis was made on the clinical data of 353 patients with unilateral monosegmental lumbar disc herniation from January 2007 to February 2013. Unilateral pedicle screw-stick and single PEEK Cage were used for the study group, and bilateral pedicle screw-stick and single PEEK Cage for the control group. Criteria such as Oswestry Disability Index (ODI), Visual Analog Scale (VAS) for pain and Macnab were used to effects of surgery.

Results:Compared with those in the control group, the patients in the study group had considerably smaller size of incision, shorter duration of operation, lower intraoperative blood loss, lower postoperative drainage and shorter length of stay and much less money spent on hospitalization (P <0.05). There was no significant difference between two groups in preoperative and postoperative intervertebral heights, fusion time and fusion rate (P >0.05). In the postoperative follow-up evaluations of ODI, VAS and postoperative curative effects of lumbar surgery, excellent and good rates of the study group were higher than those of the contract group (P <0.05).

Conclusions:Compared with bilateral pedicle screw-stick and single PEEK Cage, unilateral pedicle screw-stick and single PEEK cage are a reliable choice for the treatment of monosegmental lumbar disc herniation.

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References

Iquchi T, Kanemura A, Kasahara K, Sato K, Kurihara A, Yoshiya S, et al. Lumbar instability and clinical symptoms: which is the more critical factor for symptoms: sagittal translation or segment angulation? J Spinal Disord Tech. 2004;17(4):284-90.

Lu Yulai. Lumbar intervertebral disc herniation. Orthop J China. 2004;17(4):284-90.

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):107-13.

Dipaola CP, Molimari RW. Posterior lumbar interbody fusion. J Am Acad Orthop Surg. 2008;16(3):130-9.

Lee JK, Kim KW. Bone mineral densities of the vertebral body and intertransverse fusion mass after instrumented intertransverse process fusion. Spine (Phila Pa 1976). 2010;35(21):E1106-10.

Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976). 2004;29(17):1938-44.

Yone K, Sakou T, Kawauchi Y, Yamaguchi M, Yanase M. Indication of fusion for lumbar spinal stenosis in elderly patients and its significance. Spine (Phila Pa 1976). 1996;21(2):242-8.

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):216-7.

Kabins MB, Weinstein JN, Spratt KF, Found EM, Goel VK, Woody J, et al. Isolated L4-L5 fusions using the variable screw placement system: unilateral versus bilateral. J Spinal Disord. 1992;5(1):39-49.

Kabins MB, Weinstein JN, Spratt KF, Found EM, Goel VK, Woody J, et al. Disc height reduction in adjacent segments and clinical outcome 10 years after lumbar 360° fusion. Eur Spine J. 2007;16(12):2152-8.

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.

Chen SH, Lin SC, Tsai WC, Wang CW, Chao SH. Biomechanical comparison of unilateral and bilateral pedicle screws fixation for transforaminal lumbar interbody fusion after decompressive surgery--a finite element analysis. BMC Musculoskelet Disord. 2012;13:72.

Rahman M, Summers LE, Richter B, Mimran RI, Jacob RP. Comparison of techniques for decompressive lumbar laminectomy: the minimally invasive versus the “classic” open approach. Minim Invasive Neurosurg. 2008 Apr;51(2):100-5.

Iwatsuki K, Yoshimine T, Aoki M. Bilateral interlaminar fenestration and unroofing for the decompression of nerve roots by using a unilateral approach in lumbar canal stenosis. Surg Neurol. 2007;68(5):487-92.

Wang Shengjie, Li Xiaolong, Xia Caiwei, Liu Weifeng, Liu Jun, Yang Lei, et al. The primary clinical outcomes of lumbar interbody fusion with unilateral pedicle screw fixation. Chinese J Spine Spinal Cord. 2011;21(7):583-7.

Raynor B, Pugh J, Shapiro I. Cervical facetectomy and its effect on spine strength. J Neurosurg. 1985;63(2):278-82.

Chen HH, Cheung HH, Wang WK, Li A, Li KC. Biomechanical analysis of unilateral fixation with interbody cages. Spine (Phila Pa 1976). 2005;30(4):E92-6.

Kotil K, Ali Akçetin M, Savaş Y. Clinical and radiologic outcome of TILF applications with or without pedicle screw: a double center prospective pilot comparative study. J Spinal Disord Tech. 2013;26(7):359-66.

Sonmez E, Coven I, Sahinturk F, Yilmaz C, Caner H. Unilateral percutaneous pedicle screw instrumentation with minimally invasive TLIF for the treatment of recurrent lumbar disk disease: 2 years follow-up. Turk Neurosurg. 2013;23(3):372-8.

Shah RR, Mohammed S, Saifuddin A, Taylor BA. Radiologic evaluation of adjacent superior segment facet joint violation following transpedicular instrumentation of the lumbar spine. Spine (Phila Pa 1976). 2003 Feb;28(3):272-5.

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Published

2016-12-11

How to Cite

Jin, Z., Changlin, F., Haoqun, Y., Min, D., & Bin, Z. (2016). Use of unilateral screw-stick and cage bone graft fusion for the treatment of lumbar disc herniation. International Surgery Journal, 2(1), 70–75. Retrieved from https://www.ijsurgery.com/index.php/isj/article/view/486

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Original Research Articles