Multilevel Unilateral Pedicular Screw Fixation with Interbody Fusion in Surgery of Double- and Triple-Segment Lumbar Disc Pathology

Abstract

Background Data: In double- and triple-segment lumbar disc herniation, a facet hypertrophy is more encountered specially in the same side of disc herniation with subsequent ipsilateral concave curve scoliosis. Lumbar fixation with interbody fusion surgery is a scientific and feasible option. Some authors believe that unilateral pedicle screw fixation can provide similar biomechanical support to the traditional bilateral pedicle screw fixation. Purpose: To assess the strategy of use of unilateral pedicle screw fixation with lumbar interbody fusion in surgical treatment of multilevel (2-3) symptomatic lumbar disc herniation syndromes. Study Design: Retrospective observational analytic study. Patients and Methods: Retrospective evaluation of 216 patients' files who underwent unilateral pedicular screws fixation for management of degenerative lumbar disc pathology, from July 2007 to June 2017. Only 24 patient’s files were selected with multilevel symptomatic lumbar disc prolapse who were managed by unilateral pedicular screw fixation with interbody fusion. All patients were presented with symptoms of nerve root compression. Patients' data included age, gender, levels of disc prolapse, preoperative and postoperative Visual Analogue Scale (VAS) for back and leg and Oswestry Disability Index (ODI) for functional outcome, presence of complications, and finally patients’ satisfaction according to Odom’s criteria. VAS and ODI were retrieved preoperatively, immediately postoperatively, and 6 months postoperatively. Results: They were 18 males (75%) and 6 females (25%) with a male-to-female ratio of 3:1 and age ranging 35–63 years with a mean age of 49±9.8 years. Double-level disc prolapse was recorded in 20 (83.3%) patients, while it was triple in 4 cases (16.7%). At the last follow-up, back pain VAS improved from 7.5±1.47 to 1.12±1.03, leg pain VAS from 8.7±1.04 to 0.33±0.63, and ODI from 78±8.3 to 11.08±4.6. Excellent and good Odom’s outcomes were reported in 95% of our patients. Conclusion: Our study suggests that unilateral pedicular screw fixation with interbody fusion for the management of multiple level ipsilateral lumbar disc disease could be considered as an effective and less invasive method with satisfying clinical outcomes. (2019ESJ191)