Clinical And Radiological Outcome Of Minimally Invasive Unilateral Pedicle Screw Stabilization Versus Minimally Invasive Bilateral Pedicle Screw Stabilization For TLIF Procedures In Degenerative Single Level Lumbar Spine Diseases: A Randomized Controlled Trial
European Journal of Molecular & Clinical Medicine,
2023, Volume 10, Issue 2, Pages 87-96
AbstractObjectives: To compare Clinical outcome of degenerative lumbar single level spine diseases treated by minimally invasive unilateral pedicle screw stabilization versus minimally invasive bilateral pedicle screws stabilization for TLIF procedures assessed by VAS, ODI SCORE AND SF 36 and to compare the radiological outcome by Beck index, fusion index, vertebral alignment, proper placement of cage. To compare intraoperative blood loss, duration of surgery, length of hospital stays between the mentioned two groups.
Materials and Methods: A total of 30 patients were randomized into two groups. Group 1 underwent minimally invasive unilateral pedicle screw stabilization -TLIF (15patients) and group 2 underwent minimally invasive bilateral pedicle stabilization -TLIF (15 patients) from the period between July 2020 to July 2022 and were followed up for mean duration of 18 months. Degenerative lumbar single level involvement with spinal canal stenosis grade 2, 3 and spondylolisthesis grade 1, 2 were involved. Clinical assessment was measured with visual analogue score (VAS score), Oswestry disability index (ODI) Score and Short form health survey -36 (SF36). Radiological assessment was done with Briedwell interbody fusion index, placement of cage. And were followed up at 3 months,6 months, 12 months and 18 months after surgery.
Results: The mean Age (Years) was 52.73 ± 11.92. Out of 30 participants 15 (50.0%) had Group: MISS- U/L instrumentation –TLIF. 15 (50.0%) of the participants had Group: MISS -B/L instrumentation TLIF. Majority of them were l4-l5 involvement. There was a significant difference between the 2 groups in terms of Duration of Surgery (Minutes) (W = 0.000, p = <0.001) and intraoperative blood loss (W = 3.500, p = <0.001), with the median Duration of Surgery (Minutes) being highest in the Group: B/L TLIF group. With the median Blood Loss (mL) being highest in the Group: B/L TLIF group. There was statistically significant improvement in the trend of VAS Score, ODI score, SF-36 over time in each group after surgery but there were no statistically significant changes between these 2 groups. There were no statistically significant changes in terms of fusion and cobbs’ angle between these 2 groups.
Conclusion: MISS TLIF with unilateral pedicle screw fixation in a single level degenerative disc diseases is similar to bilateral pedicle screw fixation with added advantages of shorter operative time, lesser intraoperative blood loss, similar days of hospital stay, no statistical significant difference in post operative changes in VAS score, ODI score, SF 36 score, briedwell fusion index, cobbs angle when compared to bilateral pedicle screw instrumentation leading to early mobilization, easy rehabilitation and return to activities of daily living.
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