Short-Term Outcome of Bilateral Decompression via a Unilateral Paramedian Approach for Transforaminal Lumbar Interbody Fusion with Unilateral Pedicle Screw Fixation

Abstract

The purpose of this study was to evaluate the clinical and radiologic outcomes of bilateral decompression via a unilateral paramedian approach for transforaminal lumbar interbody fusion. Forty consecutive patients satisfying the inclusion criteria were divided randomly into groups 1 and 2. Patients were treated with unilateral (group 1) or bilateral (group 2) pedicle screw fixation and bilateral decompression via 1-sided (group 1) or bilateral (group 2) paramedian approach. Perioperative parameters (operation time, blood loss, hospital stay, complications, and implant cost), clinical outcome parameters (Japanese Orthopedic Association [JOA] scores, visual analog scale [VAS] scores, and Oswestry Disability Index [ODI] preoperatively and at 1 week and 3 months postoperatively), and radiologic parameters (radiograph and computed tomography [CT] scan preoperatively and at 1 week postoperatively) were compared.No differences were seen between groups 1 and 2 with respect to operation time, blood loss, or hospital stay. No complications were observed in either group. The ODI, JOA, and VAS values of both groups showed significant differences between the preoperative and 1-week or 3-month postoperative values. No significant differences were seen in the improvements of the ODI, JOA, and VAPS values between groups 1 and 2 at any postoperative time point. Postoperative CT indicated that the contralateral decompression was sufficient in both groups.The short-term results indicate that bilateral decompression via a unilateral paramedian approach for transforaminal lumbar interbody fusion with unilateral pedicle screw fixation is safe, feasible, and effective over the short-term and is more cost-efficient than a bilateral paramedian approach.