Unilateral pedicle screw fixation combined with translaminar facet screw fixation versus bilateral pedicle screw fixation for lower lumbar degenerative diseases: a 2-year follow-up

doi:10.3969/j.issn.2095-4344.2017.19.004

Abstract

Abstract:

BACKGROUND: Bilateral pedicle screw fixation combined with intervertebral decompression and fusion is a classic surgical approach in treatment of lumbar degenerative diseases, but it can cause ligament and other soft tissue damage of lumbar spine and degeneration of the adjacent segments. While translaminar facet screw fixation has its unique advantages.

OBJECTIVE: To compare the clinical efficacy of unilateral pedicle screw fixation combined with translaminar facet screw fixation and bilateral pedicle screw fixation for lower lumbar degenerative diseases.

METHODS: Forty-six patients with single-level lower lumbar degenerative disease were enrolled, and were then treated with bilateral pedicle screw fixation combined with intervertebral fusion (group A, n=24) or unilateral pedicle screw along with translaminar facet screw fixation and intervertebral fusion (group B, n=22). Afterwards, the clinical indexes and efficacy were compared between two groups.

RESULTS AND CONCLUSION: (1) All operations were performed successfully. The length of incision, operation time, intraoperative blood loss, postoperative drainage volume and cost of hospitalization in the group B were significantly superior to those in the group A (P < 0.05). (2) There was no significant difference in the rate of fusion between two groups (P > 0.05). (3) The visual analogue scale and Japanese Orthopaedic Association scores in both groups at 1 week, 3, 6, 12 and 24 months postoperatively were significantly improved compared with baseline (P < 0.05), but the scores had no significant differences between two groups (P > 0.05). (4) To conclude, unilateral pedicle screw fixation combined with translaminar facet screw fixation and bilateral pedicle screw fixation both exhibit satisfactory treatment outcomes, while the former holds little trauma, good stability, high fusion rate and less cost, which is a better choice for lower lumbar degenerative diseases.

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, Internal Fixators, Spinal Fusion, Tissue Engineering

CLC Number:

R318

Jiang Wei, Yuan Feng. Unilateral pedicle screw fixation combined with translaminar facet screw fixation versus bilateral pedicle screw fixation for lower lumbar degenerative diseases: a 2-year follow-up [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(19): 2973-2979.

Figures/Tables 2

2.1 参与者数量分析按意向性处理，纳入腰椎退行性疾病患者46例，按内固定方式分为2组，全部进入结果分析，无脱落。试验流程图见图2。 2.2 患者一般情况 2组患者手术切口长度、手术时间、术中出血量、术后引流量、住院费用比较见表2，结果显示，B组各项指标均优于A组，差异均有显著性意义(P < 0.05)。表明单侧椎弓根螺钉联合对侧经椎板关节突螺钉固定合并椎间融合器植骨具有创伤小、手术时间短、术中出血量和术后引流量少、住院费用少等优点。 2.3 影像学评估术后24个月的随访结果显示，固定节段椎弓根螺钉和经椎板关节突螺钉未出现松动、移位、断裂，CT显示椎板关节突螺钉位置良好。末次随访时，手术节段A组椎间隙高度为(11.51± 1.62) mm，B组椎间隙高度为(11.39± 1.74) mm，与术前对比差异均有显著性意义(P < 0.05)，而2组间对比差异无显著性意义(P > 0.05)。根据Suk评分标准，除外2例(A组1例，B组1例)不能明确是否融合，其余44例均获得椎间融合。A组24例中融合23例，融合率为96%；B组22例中融合21例，融合率为96%，2组融合率比较差异无显著性意义(P > 0.05)。 2.4 目测类比评分及JOA评分 2组术后各时间点腰痛目测类比评分及JOA评分与术前比较差异均有显著性意义 (P < 0.05)；术后各时间点腰痛目测类比评分及JOA评分2组间比较差异均无显著性意义(P > 0.05)，见表3。末次随访时JOA评分A组为22-28分，平均24.7分，改善率为61%-90%；B组为23-28分，平均25.2分，改善率为62%-90%，2组改善率比较差异无显著性意义。 2.5 不良事件行内固定联合椎间融合器植骨术治疗后2组均未见明显的不良反应，均未出现植入物宿主反应。 2.6 典型病例男性患者，64岁，腰痛2年，加重伴左下肢放射痛半年，术前腰椎MRI显示L5-S1巨大腰椎间盘脱出，给予L5-S1同侧椎弓根螺钉联合对侧经椎板关节突螺钉固定合并椎间融合器植骨治疗，相关影像学图片见图3。"

References

[1] Park P, Garton HJ, Gala VC, et al. Adjacent segment disease after lumbar or lumbosacral fusion:review of the literature. Spine.2004;29(17):1938-1944.

[2] Magerl FP. Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop Relat Res.1984; 189:125-141.

[3] Ferrara LA, Secor JL, Jin BH, et al. A biomechanical comparison of facet screw fixation and pedicle screw fixation：effects of short-term and long-term repetitive cycling. Spine (Phila Pa 1976).2003;28(12):1226-1234.

[4] 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 J. 2013 ;13(10):1208-1216.

[5] Imagama S,Kawakami N,Matsubara Y, et al. Radiographic Adjacent Segment Degeneration at 5 Years After L4/5 Posterior Lumbar Interbody Fusion With Pedicle Screw Instrumentation: Evaluation by Computed Tomography and Annual Screening With Magnetic Resonance Imaging.Clin Spine Surg.2016;29(9):442-451.

[6] Xie Y, Ma H, Li H, et al. Comparative study of unilateral and bilateral pedicle screw fixation in posterior lumbar interbody fusion. Orthopedics. 2012;35(10):1517-1523.

[7] Minghua X, Yihui T,Minwei C. Comparison of unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in degenerative lumbar disease. J Spine. 2012;12(3):209-215.

[8] Deutsch H, Musacchio MJ. Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation. Neurosurg Focus. 2006;20:E10.

[9] Goel VK,Lim TH,Gwon J.et al.Effects of an internal fixation device:a comprehensive biomechanical investigation. Spine. 1991;16(3 Suppl):155-161.

[10] Mao L ,Yang HL,Tang TS. Postoperative back pain of opposite lumbosacral area attribute to unilateral fixation with diagonal cage-instrumented transforaminal lumbar interbody fusion. J Chin Orthopedic .2012;24:2260-2263.

[11] Suk KS, Lee HM, Kim NH, et al. Unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion. Spine. 2000; 25(14):1843-1847.

[12] Reich SM,Kuflik P,Neuwirth M. Translaminar facet screw fixation in lumbar spine fusion. spine(Phila Pa 1976).1993; 18(4):444-449.

[13] Kornblatt MD,Casey MP,Jacobs RR．Internal fixation in lumbosacral spine fusion．A biomechanical and clinical study. Clin Orthop Relat Res.1986;203:141-150.

[14] Heggeness MH,Esses SI. Translaminar facet joint screw fixation for lumbar and lumbosacral fusion．A clinical and biomechanical study．Spine(Phila Pa 1976).1991;16(Suppl 6):S266-S269.

[15] Deguchi M, Cheng BC, Sato K, et al. Biomechanical evaluation of translaminar facet joint fixation. A comparative study of poly-L-lactide pins, screws, and pedicle fixation.Spine(Phila Pa 1976).1998;23(12):1307-1312.

[16] Eskander M,Brooks D,Ordway N,et al. Analysis of pedicle and translaminar facet fixation in a multisegment interbody fusion model．Spine(Phila Pa 1976).2007;32(7):E230-E235.

[17] Apli M,Mannion AF,Grob D.Translaminar screw fixation of the lumbar spine:long-term outcome. Spine(Phila Pa 1976).2009; 34(14):1492-1498.

[18] Jacobs RR,Montesano PX,Jackson RP. Enhancemem of lumbar spine fusion by use of translaminar facet joint screws. Spine(Phila Pa 1976).1989:14(1):12-15.

[19] Shim CS,Lee SH,Jung B,et al. Fluoroscopically assisted percutaneous translaminar facet screw fixation following anterior lumbar interhody fusion: technical report．Spine(Phila Pa 1976).2005;30(7):838-843.

[20] Wang M,Tang SJ,McGrady LM,et al. Biomechanical comparison of supplemental posterior fixations for two-level anterior lumbar interbody fusion.Proc Inst Mech Eng.2013; 227(3):245-250.

[21] Zhan Y,Tian D. Do translaminar facet screws have the same stability as pedicle screws in two-level anterior lumbar interbody fusion? A biomechanical study.Turk Neurosurg. 2012;22(5):630-633.

[22] Hou Y, Shen Y, Liu Z, et al. Which posterior instrumentation is better for two-level anterior lumbar interbody fusion: translaminar facet screw or pedicle screw?Arch Orthop Trauma Surg.2013;133(1):37-42.

[23] Frantzides CT, Zeni TM, Phillips FM, et al. L5-S1 laparoseopic anterior interbody fusion. JSLS.2006;10:488-492.

[24] Rick C,Sasso J, Burkus K,et al．Retrograde ejaculation after anterior lumbar interbody fusion.Spine.2003;28:1023.

[25] Cao Y, Chen Z, Jiang C,et al. The combined use of unilateral pedicle screw and contralateral facet joint screw fixation in transforaminal lumbar interbody fusion.Eur Spine J.2015; 24(11):2607-2613.

[26] 曾忠友,严卫锋,陈国军,等．单侧椎弓根螺钉联合对侧椎板关节突螺钉固定并椎间融合治疗下腰椎病变的临床观察[J].中华骨科杂志,2011,31(8):834-839．

[27] 曾忠友,张建乔,严卫锋,等.椎板关节突螺钉瞄准器在治疗下腰椎退行性病变的临床应用[J].中国矫形外科杂志,2011,19(5): 378-381.

[28] 曾忠友,吴鹏,宋永新,等.小切口单侧椎弓根螺钉联合对侧经皮椎板关节突螺钉固定并椎间融合治疗腰椎病变的并发症分析[J].中国骨伤,2016,29(3):232-241.

[29] Liu F, Cao Y, Feng Z,et al. Comparison of three different posterior fixation techniques in transforaminal lumbar interbody fusion for two-level lumbar degenerative diseases: At a mean follow up time of 46 months.Clin Neurol Neurosurg. 2016 ;141:1-6.

[30] Liu F, Jiang C, Cao Y, et al. Transforaminal lumbar interbody fusion using unilateral pedicle screw fixation plus contralateral translaminar facet screw fixation in lumbar degenerative diseases. Indian J Orthop.2014 ;48(4):374-379.

[31] Gong Z, Chen Z, Feng Z, et al. Finite element analysis of 3 posterior fixation techniques in the lumbar spine.Orthopedics. 2014 ;37(5):441-448.

[32] Amoretti N, Amoretti ME, Hovorka I,et al. Percutaneous facet screw fixation of lumbar spine with CT and fluoroscopic guidance: a feasibility study.Radiology.2013; 268(2):548-555.

[33] 毛克亚,王岩,肖嵩华,等.单侧微创经椎间孔腰椎体间融合术采用椎弓根螺钉结合经椎板关节突螺钉混合内固定可行性研究[J].中华外科杂志,2011,49(12):1067-1070.

[34] Park SH,Park WM,Park CW, et al. Minimally invasive anterior lumbar interbody fusion followed by percutaneous translaminar facet screw fixation in elderly patients. J Neurosurg Spine.2009;10(6):610-616.

[35] 陶勇,吴云乐,宗少晖,等. 基于有限元分析腰椎内固定的生物力学特征[J].中国组织工程研究,2016,20(13):1932-1938.

[36] Chen SH,Lin SC,Tsai WC, et al. Biomechanical comparison of unilateral and bilateral pedicle screws fixation for transforaminal lumbar interbody fusion after decompressive surgery--a finite element analysis. BMC Musculoskelet Disord. 2012;13:72.

[37] 陆声,徐永清,丁自海,等. 经皮椎板关节突螺钉固定的应用解剖及影像学研究[J]. 中国矫形外科杂志, 2006, 14(5):351-352.