The Analysis Of The Effect Of The Lumbar Interbody Fusion Using Pedicle Screw And Facet Screw

Objective: The purpose of this study was to explore the clinical effect of the transforaminal lumbar interbody fusion using unilateral pedicle screw and contralateral facet screw for the lumbar degenerative disease and the value of unilateral pedicle screw and contralateral facet screw fixation in lumbar interbody fusion.Methods: From April 2010 to October 2010,forty-three patients (twenty men and twenty-three women) underwent the transforaminal lumbar interbody fusion using unilateral pedicle screw and contralateral facet screw . The ages were 42 to 79 yeaars with an average of 58.4 years.spinal stenosis 18 cases,spondylolisthesis 10 cases,lumar disc herniation 4 cases, spinal stenosis and spondylolisthesis 8 cases, lumar disc herniation and spondylolisthesis 3 cases.All patients had low back pain,40 patients had leg pain.Thirty-four patients underwent one-level fusion and nine patients underwent two-level fusion.The follow-up period ranged from 6 to 12 months with a mean of 9.8 months. A clinical and radiographic evaluation was carried out preoperatively and at multiple time points following surgery for all patients. The Japanese Orthopaedic Association (JOA) scores and visual analogue scales (VAS) for leg and back pain was observed. The bony fusion rate was calculated.Results: The mean JOA scores ranged from 10.62±1.12 before the surgery to 20.66±1.86 at 1 week after operation,23.53±1.92 at 6 months after operation,23.74±2.01 at 9 months after operation, 23.75±2.42 at 1 year after operation,the difference was statistically significant(P<0.01). The improvement rate is 54.62±6.38 at 1 week after operation, 70.26±6.64 at 6 months after operation,71.38±8.65 at 9 months after operation,71.42±7.26 at 1 year after operation. The VAS scores ranged from 6.28±0.58 (back pain) and 5.44±0.61 (leg pain) before the surgery to 2.14±0.26 and 1.87±0.22 at 1 week after operation,1.88±0.21 and 1.48±0.13 at 6 months after operation,1.62±0.14 and 1.04±0.11 at 9 months after operation, 0.92±0.11 and 0.88±0.08 at 1 year after operation. the difference was statistically significant(P<0.01). The bony fusion rate was 14.0% at 1 week after operation, 88.4% at 6 months after operation and 91.3% at 9 months after operation. The bony fusion rate was 100% at 12 months after operation, but it needs further observation because the number of cases in this group is only 6.Conclusions:The transforaminal lumbar interbody fusion using unilateral pedicle screw and contralateral facet screw is a straightforward and effectively technique.It can reduce EBL ,diminished soft-tissue injury and effectively relieve clinical symptom. The unilateral pedicle screw and contralateral facet screw fixation can provide effective stability to the spine .