Comparison Of Efficacy Of Unilateral And Bilateral Pedicle Screw Fixation Combined With Interbody Fusion In The Treatment Of Lumbar Spinal Stenosis With Unilateral Neurological Symptoms

ObjectiveThis research was designed to explore the differences of intraoperative blood loss,length of hospital stay,hospitalization cost,lumbar and leg pain score,ODI index,JOA score,interbody fusion rate,and postoperative quality of life between unilateral and bilateral pedicle screw internal fixation in the treatment of debilitating lumbar spinal stenosis patients with unilateral neurological symptoms,and to provide help for clinical selection.MethodsTotally 85 patients with degenerative lumbar spinal stenosis admitted in our hospital from February 2016 to December 2018 were collected as the research objects.Among them,45 received bilateral pedicle screw fixation(BPSF)and 40 were treated by unilateral pedicle screw fixation(UPSF).Inclusion criteria:1.All patients were diagnosed with degenerative lumbar spinal stenosis by CT and MRI examination;2.Accompanied by unilateral limb neurological symptoms:low back pain and(or)leg pain,can be accompanied by lower limb numbness or intermittent claudication;3.It is invalid after more than 3 months of conservative treatment;4.No use of anticoagulants or withdrawal of anticoagulants for more than 1 week;5.the general condition is OK,can tolerate the operation.SPSS21.0 statistical software was used for data analysis.The amount of intraoperative blood loss,operation time and hospital stay were compared between the two groups.The incidence of perioperative complications was compared between the two groups.The VAS scores of low back pain and leg pain were compared between the two groups before treatment,1 week,1 month,3 months,6 months and 12 months after treatment.ODI index and JOA score were compared between the two groups before treatment,1 month,3 months,6 months and 12 months after treatment.Interbody fusion rates were compared between the two groups at 3 months,6 months and 12 months after treatment.ResultsThe amount of intraoperative blood loss in the observation group was lower than that in the control group(P<0.05),and the duration of operation and hospital stay in the observation group as well as costs were also significantly shorter than that in the control group(P<0.05).There was no significant difference in the incidence of perioperative complications between the two groups(P BBB 0 0.05).Before treatment,there were no significant differences in VAS score,VAS score,ODI index and JOA score between two groups(P>0.05).VAS scores of low back pain and leg pain at 1 week,1 month,3 months,6 months and 12 months after treatment were significantly lower than those before treatment.At 1 month,3 months,6 months and 12 months after treatment,ODI index was lower than before treatment,and JOA score was higher than before treatment.VAS scores in the observation group were significantly lower than those in the control group at 1 week and 1 month after treatment(P<0.05).After 1 month of treatment,ODI index in observation group was significantly lower than control group,while JOA score was significantly higher than control group(P<0.05).There was no significant difference in the VAS scores of leg pain between the observation group and the control group at 1 week,1 month,3 months,6 months and 12 months after treatment(P>0.05).There were no significant differences in VAS score,VAS score,ODI index and JOA score between observation group and control group at 3,6 and 12 months after treatment(P>0.05).There was no significant difference in the interbody fusion rate between the observation group and the control group at 3,6 and 12 months after treatment(P>0.05).ConclusionBoth lateral and bilateral pedicle screw fixation for patients with degenerative lumbar spinal stenosis with unilateral neurological symptoms can relieve pain,has good curative effect and security.Unilateral pedicle screw fixation advantages in shorter operation time,lower hospitalization costs,lower intraoperative bleeding,shorter hospital stay,less pain relief for patients with early more apparent,more conducive to patients early rehabilitation exercise.