Posterior Lumbar Intebody Fusion with Unilateral Transpedicular Screw and Contralateral Translaminar Facet Screw Fixation in Lumbar Spinal Stenosis

Ki-Soo Kim; Yong-Soo Choi; Chae-Hyun Lim; Kyung-Ho Park

doi:10.4184/jkss.2007.14.3.171

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Kim, Choi, Lim, and Park: Posterior Lumbar Intebody Fusion with Unilateral Transpedicular Screw and Contralateral Translaminar Facet Screw Fixation in Lumbar Spinal Stenosis

Original Article

Journal of Korean Spine Surg 2007;14(3):171-177.

Published online: 21 February 2007

DOI: https://doi.org/10.4184/jkss.2007.14.3.171

Posterior Lumbar Intebody Fusion with Unilateral Transpedicular Screw and Contralateral Translaminar Facet Screw Fixation in Lumbar Spinal Stenosis

Ki-Soo Kim, M.D., Yong-Soo Choi, M.D., Chae-Hyun Lim, M.D., Kyung-Ho Park, M.D.

Department of Orthopedic Surgery, Kwangju Christian Hospital

Address reprint requests to Yong-Soo Choi, M.D. Department of Orthopedics, Kwangju Christian Hospital,264 Yanglim-dong, Nam-gu, Gwangju 503-715 Korea Tel: 82-62-650-5062, Fax: 82-62-650-5066, E-mail: stemcellchoi@yahoo.co.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A retrospective study.

Objectives

To describe the surgical procedure and assess the results of an unilateral transpedicular screw and contralateral translaminar facet screw fixation in degenerative lumbar stenosis.

Summary of Literature Review

A drawback of conventional lumbar fusion is the extensive soft-tissue destruction that is essential when inserting a screw and preparing the fusion bed. The development of a procedure that minimizes the tissue trauma without compromising the effectiveness of the conventional posterior lumbar interbody fusion (PLIF) should be pursued in lumbar spinal stenosis.

Materials and Methods

From August 2004 to November 2005, PLIF was performed on 25 consecutive patients who had lumbar spinal stenosis. Among them, 10 patients underwent with unilateral transpedicular screw and contralateral translaminar facet screw fixation (Group 1), and 15 patients underwent traditional bilateral transpedicular screw fixation (Group 2). The clinical and radiological results in the two groups were compared.

Results

The mean followup was 17.6 and 20.5 months in Groups 1 and 2, respectively. Group 1 had less blood loss, fewer transfusion requirements (P<0.05) in the surgical procedure, and less postoperative back pain (P<0.05). There was no significant difference between the two groups in the clinical results such as the VAS score for back pain and the Kirkadly-Willis criteria at the last followup, and the radiological results such as the changes in the disc height and interbody fusion.

Conclusion

The PLIF with unilateral transpedicular screw and contralateral translaminar facet screw fixation in lumbar spinal stenosis has advantages over conventional PLIF of less soft tissue injury, and produces good clinical results.

Keywords: Lumbar spinal stenosis, Posterior lumbar interbody fusion, Translaminar facet screw

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Figures and Tables%

Fig. 1.

(A) An operative finding shows unilateral transpedicular fixation and screw head at spinous process for contralateral facet fixation. (B) The schematic presentation shows unilateral transpedicular screw fixation and contralateral facet screw fixation.

Fig. 2.

(A) The radiographs demonstrate posterior lumbar interbody fusion with cage and unilateral pedicular screw fixation and contralateral facet screw fixation. (B) On radiographs at 24 months follow up after operation shows well interbody fusion.

Table 1.

Results of surgical procedure.

	Group I	Group II	^† P-value
operation time (minutes)	258±44	257±47	1
preoperative Hgb* (mg/dl)	13.7	13.1	0.36
postoperative Hgb* (mg/dl)	12.1	10.3	0.043
intraoperative bleeding (ml)	590±331	889±573	0.244
blood transfusion (ml)	100	600	0.005
output of hemovac (ml)	302±164	771±317	0.002

Hgb* : Hemoglobin

^† Statistical analysis : Mann-Whitney Test

Table 2.

Clinical and Radiological data of Group I and Group II

Group I	Group II	*P-value
Visual Analog Scale score
POD^† # 4	7.5±0.7	8.9±0.9	0.01
Last F/U^†	3.8±1.3	3.6±1.6	0.674
Kerkaldy-Willis score
Excellent	3	2
Good	5	11
Fair	2	2
Poor	0	0
Change of Disc height
POD^† #1	14% restoration	11% restoration	0.883
Last F/U^†	2% loss	1% loss	0.953

^∗ Mann-Whitney test for statistical analysis POD

^† : postoperative day Last F/U

^† : last followup

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