Research of Compare Unilateral Fixation with Bilateral Fixation MIS-TILF Technique

Abstract

Introduction Unilateral fixation MIS-TLIF has less trauma, fewer scar, and shorter operation time than standard bilateral fixation MIS-TLIF. But the debatement of fixation on biomechanical strength and clinical effects is not stopped. So, in our research, we tried to confirm safety and effectivity of unilateral fixation MIS-TLIF. Materials and Methods Our research retrospectively reviewed 17 cases undergoing unilateral fixation MIS-TLIF in Ruijin Hospital during August 2010 to March 2012, and chose 21 cases undergoing bilateral fixation MIS-TLIF randomly during that period as control group. The operation time, intraoperative blood volume, duration of hospital stay, and complications were recorded in both the two groups. Preoperative and postoperative ODI scores were compared between both the two groups and the statistical differences of ODI score at final follow-up was compared. Especially in cases having low back pain/leg pain, pre- and postoperative VAS scores were compared between the two groups and the statistical differences of VAS score at final follow-up was compared. Also, radiation exposure dose and time in both groups were compared; X-ray and 2D CT image reconstruction were used to evaluate whether bony infusion or not. Results The average follow-up was 24.2 months. All cases achieved bony infusion confirmed by radiography. The intraoperative blood loss volume in unilateral fixation group was 25.50 ± 15.20 mL, whereas which was 43.30 ± 8.25 mL in bilateral fixation group. The duration of hospital stay was 5 days in unilateral fixation group, whereas 7.9 days in bilateral fixation group. At the aspect of complications, one case suffered in unilateral fixation group (one case of dural laceration) and two cases suffered in bilateral fixation group (one case of dural laceration, one case of incision infection). The preoperative ODI score was 77.23 ± 12.40 and the final follow-up ODI score was 12.34 ± 9.34 in unilateral fixation group; the preoperative VAS score for low back pain/leg pain cases was 6.3 ± 2.1 and the final follow-up VAS score was 2.3 ± 1.1. The preoperative ODI score was 79.14 ± 9.21 and the final follow-up ODI score was 13.34 ± 11.28 in bilateral fixation group; the preoperative VAS score for low back pain/leg pain cases was 5.4 ± 2.3 and the final follow-up VAS score was 2.4 ± 1.2. Radiation exposure dose and time were significantly lower in unilateral fixation group than that in bilateral fixation group. There was a significant statistical difference between the two groups in intraoperative blood loss, duration of hospital stay, and radiation exposure dose, but no statistical difference was confirmed at the aspect of function score, pain score, and complications. Conclusion Unilateral fixation MIS-TLIF is similar to bilateral fixation MIS-TLIF in clinical effectivity and safety. Unilateral fixation MIS-TLIF has obvious advantage in intraoperative blood loss, duration of hospital stay, and radiation exposure. Disclosure of Interest None declared