Lumbar unilateral and bilateral interbody fusion with internal fixation versus non-internal fixation for treating lumbar disc herniation

doi:10.3969/j.issn.2095-4344.2016.53.005

Abstract

Abstract:

BACKGROUND: At present, there are many types of surgeries for lumbar disc herniation, mainly removal of intervertebral disc and nerve root compression to lessen patient’s symptoms, containing lumbar interbody fusion with internal fixation and non-internal fixation.

OBJECTIVE: To compare the efficacy of lumbar interbody fusion with internal fixation and non-internal fixation for treating lumbar disc herniation.

METHODS: Clinical data of 563 cases of lumbar disc herniation were retrospectively analyzed. According to repair methods, patients were assigned to internal fixation group (group A; n=348) and non-internal fixation group (group B; n=215). The group A was subdivided into unilateral fixation group (group A1; n=107) and bilateral fixation group (group A2; n=241). The group B was subdivided into microendoscopic discectomy group (group B1; n=125) and decompression group (group B2; n=90). Operative time, intraoperative blood loss, postoperative hospital stay, operation cost and related complications were recorded in each group. Visual Analogue Scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores and Oswestry Disability Index (ODI) were compared among the four groups at 1, 3, 6 and 12 months after surgery. Macnab clinical efficacy was evaluated after postoperative 12 months.

RESULTS AND CONCLUSION: (1) Postoperative VAS scores, JOA scores and ODI scores were significantly improved in each group (P < 0.05) compared with preoperative scores. Following up 1 year postoperatively, postoperative VAS scores, JOA scores, and ODI scores were not significantly different among the four groups (P > 0.05). There was no significant difference in Macnab clinical efficacy postoperatively (P > 0.05). (2) Intraoperative nerve root injury, cerebrospinal fluid leakage and the incidence of postoperative infection were not significantly different (P > 0.05), but significant differences in postoperative recurrence rate were detected (P < 0.05). Postoperative recurrence of group B1 was obviously higher than that of other three groups. (3) Intraoperative blood loss, operative time, postoperative hospital stay and surgery cost were significantly different (P < 0.05). Intraoperative blood loss and postoperative hospitalization stay of group B1 were obviously lower than other three groups. Operation time and surgery cost of group B2 were obviously lower than the other three groups. (4) These results suggested that the treatment of lumbar disc herniation surgery was varied, including internal fixation and non-internal fixation. Satisfactory results can be obtained in a short period. Both can be used as an effective method for repairing lumbar disc herniation.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Lumbar Vertebrae, Intervertebral Disk Displacement, Internal Fixators, Tissue Engineering

CLC Number:

R318

Wang Hua-jin, Zhang Jian, Sheng Wei-bin. Lumbar unilateral and bilateral interbody fusion with internal fixation versus non-internal fixation for treating lumbar disc herniation[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(53): 7939-7945.

Figures/Tables 2

References

[1]        Lee JY, Patel AA. Lumbar spinal stenosis and degenerative spondylolisthesis.Semin Spine Surg. 2013;25(4):256-262.

[2]        Ambati DV, Wright EK Jr, Lehman RA Jr, et al. Bilateral pedicle screw fixation provides superior biomechanical stability in transforaminal lumbar interbody fusion: a finite element study. Spine. 2015;15(8):1812-1822.

[3]        Shen XL, Zhang HL, Gu X, et al. Unilateral versus bilateral pedicle screw instrumentation for single-level minimally invasive transforaminal lumbar interbody fusion. Spine. 2014;21(9):1612-1616.

[4]        Xue HM, Tu YH, Cai MW. Comparison of unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in degenerative lumbar diseases. Spine J. 2012;12(3):209-215.

[5]        Luo JQ, Gong M, Gao MM, et al. Both unilateral and bilateral pedicle screw fixation are effective for lumbar spinal fusion-A meta-analysis-based systematic review. J Orthop Trans.2014;2(2):66-74.

[6]        Zang JC,Ma XL,Wang T,et al. Unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion: a meta-analysis of available evidence. Zhonghua Wai Ke Za Zhi. 2012;50(9):848-853.

[7]        Tomlinson T,Chen J,Upasani V, et al. Unilateral and bilateral sacropelvic fixation result in similar construct biomechanics. Spine (Phila Pa 1976). 2008;33(20): 2127-2133.

[8]        Kim TH, Lee BH, Moon SH, et al. Comparison of adjacent segment degeneration after successful posterolateral fusion with unilateral or bilateral pedicle screw instrumentation: a minimum 10-year follow-up. Spine. 2013;13(10):1208-1216.

[9]        Dewing CB, Provencher MT, Riffenburgh RH, et al. The Outcomes of Lumbar Microdiscectomy in a Young, Active Population Correlation by Herniation Type and Level. Spine (Phila Pa 1976). 2008;33(1):33-38.

[10]    Dirksmeier PJ, Kang JD. Microendoscopic lumbardisc. Oper Tech Orthop.2000;10(4):282-287.

[11]    Wang XS, Sun RF, Ji Q, et al. A meta-analysis of interlaminar minimally invasive discectomycompared to conventional microdiscectomy for lumbar disk herniation. Clin Neurol Neurosurg. 2014;127:149-157.

[12]    Casal-Moro R, Castro-Menéndez M, del Campo-Pérez V,et al. Learning Curve of Microendoscopic Discectomy for the Treatment of Lumbar Disc Herniation. Rev Esp Cir Ortop Traumatol. 2010;54(5): 272-279.

[13]    Dasenbrock HH, Juraschek SP, Schultz LR, et al. The efficacy of minimally invasive discectomy compared with open discectomy: a meta-analysis of prospective randomized controlled trials. Spine. 2012;16(5): 452-462.

[14]    Nakagawa H, Kamimura M, Uchiyama S,et al. Microendoscopic discectomy (MED) for lumbar disc prolapse. J Clin Neurosci. 2003;10(2): 231-235.

[15]    Matsumoto M, Watanabe K, Hosogane N, et al. Recurrence of lumbar disc herniation after microendoscopic discectomy. J Neurol Surg A Cent Eur Neurosurg. 2013;74(4):222-227.