Transpedicular Screw Fixation for Microinstability in Recurrent Lumbar Disc

Abstract

Background: Microinstability represents the first phase of the degenerative cascade and has specific pathoanatomical and clinical characteristics (low back pain) in the interested vertebral segment, without the presence of spondylolisthesis it is more prominent in recurrent lumbar disc. Objective: The objective of this study is to evaluate the surgical outcome of trans-pedicular screw fixation for microinstability in recurrent lumbar disc herniation with ipsilateral or bilateral transpedicular screw fixation, with highlights on lumbosacral instability classification. Patients and Methods: Two hundred patients with recurrent lumbar disc herniation were managed surgically by discectomy, curettage and unilateral transpedicular screw fixation at the offending side (100 patients among 200 patients of recurrent lumbar disc), or discectomy with endplate curettage and bilateral transpedicular screw fixation (100 patients among 200 patients of recurrent lumbar disc). Results: No significant difference was reported between both groups regarding patient age, gender, level of the disc. Surgery was on left side in 120 patients. The clinical outcome at the last follow up visit revealed that, recurrence and dural tears were confined to group A (unilateral) (each was reported in 1 patient), while root injury and spinal instability were confined to group B (Bilateral) (one patient for each. The recovery rate was 0.888 for group A and 0.807 for group B, with statistically significant difference. Conclusion: unilateral transpedicular screw fixation for recurrent lumbar disc provides slightly better outcome than bilateral approach, especially for recovery rate.