Unilateral Pedicular Screws and Interbody Lumbar Spine Fusion in Unilateral Degenerative Pathology (Technique and Outcome)

Introduction: Lumbar degenerative diseases (LDD) is considered a common disease. Lumbar pedicular screw fixation and interbody fusion is one of the com¬monly used and effective surgical method in management of single-level lumbar degenerative diseases. Although bilateral pedicular screw (PS) fixation after lumbar interbody fusion is accepted as a standard surgical procedure providing rigid fixation with a great biomechanical stability and clinical benefits, the rigidity of bilateral (PS) fixation can cause device-related osteoporosis of the vertebrae which makes the adjacent segment prone to load and motion-induced degeneration. Therefore, the concept of using less rigid systems of fixation has been advocated. Aim of study: To evaluate effectiveness of unilateral pedicular screws fixation and interbody fusion in unilateral degenerative spine pathology. Patients and methods: This study included 34 patients with single level degenerative lumbar spine disease who were subjected to transforaminal interbody lumbar fusion (TILF) and unilateral transpedicular screws fixation between July 2017 and March 2019 in Ain Shams University hospitals. Results: The study was conducted on 34 patients with age ranging between 32-56 years (mean 45.12±7.80 years). There were 17 male and 17 female in this study. When comparing VAS back pain preoperatively and at postoperative intervals of 1,6 and 12 months, it showed highly significant improvement (P-value 0.000). Also when comparing VAS of leg pain preoperatively and at postoperative intervals of 1,6 and 12 months duration, it showed highly significant improvement (P-value 0.000). ODI preoperatively and at postoperative intervals of 1,6 and 12 months showed also highly significant improvement (P-value 0.000). Regarding the fusion rate, at 6 months postoperative 61.8% (21) of the patients had fusion grade 1,26.5% (9) of the patients had fusion grade 2 and 11.8% (4) of the patients had fusion grade 3. While at 12 months postoperative the percent of grade 1 fusion increased to become 85.3% (29 patients) and the rest were grade 2 fusions (14.7%) with no patients with grade 3 fusion. Conclusion: Unilateral pedicular screws and interbody fusion is a good modality of treatment for unilateral degenerative spine pathology.