Clinical Research In Treatment Of Lumbar Degenerative Disease By Lumbar Interbody Fusion With Unilateral Pedicle Screw Fixation And Single Cage

Objective To explore the clinical efficacy of surgery,which is posterior unilateral pedicle screw fixation combined with single cage, for the treatment of lumbar degenerative disease.Methods Degenerative-lumbar-disease patients(67 cases, male 41 cases, female 26 cases) were to be adopted unilateral posterior lumbar pedicle fixation and fusion. The patients aged from 38 to 72 years (mean 58.3 years). The sick time was 3 months-17 years. The clinical symptoms of all the patients were pain and numbness at one side of bilateral lower extremity, 59 cases single segment (L_3,4 3 cases, L₉4,5) 31 cases, L₅S₁ 25 cases), 8 cases double segments(L₄₅ combined with L₅S₁). Lumbar Disc Herniation combined with lumbar instability was 21 cases.The huge lumbar disc herniation combined with severe low back pain (MODIC change significantly) were 11 cases.The lumbar spinal stenosis with degenerative instability were 32 cases. The lumbar posterior marginal diagnosis (ossification wide) were 3 cases.All of the patients ,underwent posterior lateral lumbar pedicle fixation, were used Japanese postoperative JOA score to assess efficacy.Results The mean bleed in the single segment surgery was 131ml, and double segements was 213ml. Total surgery time was 45 - 170 min. (single segment 92min, double segements 143min).The time that the patients stayed in the hospital was average 16.3 days (from12 to 22 days). None of the patients got incision infection. The patients were followed-up by 13months( 5 -28 months). The results that accorded to the Japanese JOA score assessment were: excellent in 52 cases (77.61%), good in 12 cases (17.91%), fair in 3 cases (4.48%),no bad cases.The excellent and good cases accounted for 95.52%. The pedicle screw,which was examed by the postoperative X-ray,did not loose,pull out and broke.The fusion rate was 95.5%,yet 3 cases could fusion.Conclusion The unilateral pedicle screw with single fixed interbody fusion cage was carried out for disorders of the lumbar spine surgery in recent years and achieved good results in the near future.It worthed clinical application. Compared to conventional bilateral spondylolysis fixation,it has the following advantages: 1. There was no need to strip the other side of paravertebral muscles from the lamina.Without damaging to spine, the interspinous ligaments. The exposure time was reduced,with less bleeding. 2. It avoided to damage contralateral paravertebral facet joint excessively and maintained the stability of the spine; 3. Single fusion cage with unilateral pedicle screws are required,and droped the medical costs. The rate of fusion was higher. 4.The unilateral decompression and unilateral cage placement avoided excessive interference to the dural sac and reduced the risk of surgery.