Comparison Of The Adjacent Segment Degeneration And Surgical Outcomes Of Unilateral Versus Bilateral Pedicle Screw Fixation With Transforaminal Lumbar Interbody Fusion In Degenerative Lumbar Diseases

ObjectivesTo study the clinical effect and the adjacent segment degeneration of the patients who underwent the unilateral or bilateral pedicle screw fixation with transforaminal lumbar interbody fusion in degenerative lumbar diseases.MethodsSelecting the patients who underwent the unilateral or bilateral pedicle screw fixation with transforaminal lumbar interbody fusion from 2010 to 2016 in Traditionnal Chinese Medicine Hospital of Guangdong Province. According to the case data and scale, operation method, we divided the cases into unilateral internal fixation group and traditional TLIF group. Investigation of life characteristics (age, gender), the current condition (preoperative VAS, JOA score), to determine the general data of two groups of patients with no statistically significant difference. By the same with Deputy director of the of surgery doctors completed the operation, to reduce the error of the technology. And recording two groups of surgery in patients with preoperative and postoperative X-ray data measurement, and the VAS of the last follow-up after operation, JOA score, University of California, Los Angeles; for UCLA.Through the study of the statistical analysis of log data to evaluate the operation of the two groups of surgery group operability, damage, effectiveness and lumbar fusion, For the choice of clinical treatment and provide basis for clinical research.Results1. General information:patient age on unilateral fixed fusion group was 47.23±10.58yearsold, (p＜0.05), Traditional lumbar TLIF group was 49.72 ±11.00 years old, and there is no statistical difference of patients with age, sex ratio, gender clinical data comparable (P> 0.05).2. Unilateral fixed fusion group of preoperative VAS score:7.70±1.82 point, preoperative JOA score:14.30±1.82;Double side fixed fusion group of preoperative VAS score:7.92+0.94 points, preoperative JOA score:14.24 ±1.20 after the comparison, preoperative VAS, JOA score was no significant difference (P> 0.05);Unilateral fixed fusion group after 3 months postoperative VAS score and JOA score were:4.10±1.16,18.94±1.30 group 3 months after bilateral fixed fusion VAS score and JOA score were:1.52± 0.79,19.12±1.17, after comparison, three months after comparing differences statistically significant (P< 0.05), the double side fixed fusion group than unilateral fixed group can get better clinical curative effect;Unilateral group began six months after a fixed fusion VAS score and JOA score were: 1.46±0.89,24.861.09 double side fixed fusion group 6 months after VAS score and JOA score were:1.46±0.73 points,24.72±1.78 points, after comparison, no significant statistical differences between two groups of data;Unilateral fixed fusion group after 12 months postoperative VAS score and JOA score were: 1.52±1.05 points,26.841.17 mm,12 months after bilateral fixed fusion group VAS score and JOA score were:1.50±0.84 points,26.54±1.18,after comparison, no significant statistical differences between two groups of data;Unilateral fixed fusion group after 24 months postoperative VAS score and JOA score were:0.78±0.71,0.71±1.09, double side fixed fusion group of 24 months after the VAS score and JOA score were 0.88±0.81,0.81±0.87, after comparison, no significant statistical differences between two groups of data. After 24 months, with the University of California (University of California, Los Angeles; for UCLA) score evaluation in the two groups, postoperative observation of the adjacent segment degeneration in group A (unilateral fixed fusion group) and group B (traditional lumbar TLIF group) compared by chi-square test, there was no statistically significant difference (P> 0.05).ConclusionUnilateral pedicle screw fixation and intervertebral fusion, with less bleeding, shorter operation time, small trauma, early pain, costs are relatively low, the risk is relatively small, early engaged in activities, quicker recovery, etc. Unilateral or bilateral pedicle screw joint by the intervertebral foramen intervertebral fusion treatment of lumbar degenerative disease all can obtain satisfactory clinical effect, The postoperative long-term influence on adjacent segment degeneration is no statistical difference.