| Objective: To compare the clinical and radiological outcomes of unilateral and bilateral pedicle screws fixations combined with Oblique lateral interbody fusion(OLIF)in treating degenerative lumbar diseases.Methods: The clinical data of 41 patients with single-level degenerative lumbar spine diseases treated from February 2018 to February 2019 were analyzed retrospectively.According to the surgical ways,the patients were divided into two groups: OLIF combined with unilateral pedicle screw fixation group(Unilateral fixation group,n =18 cases)and OLIF combined with bilateral pedicle screw fixation group(Bilateral fixation group,n = 23 cases).The operation time,intraoperative hemorrhage and hospitalization days were compared between the two groups.The disc height(DH)and segmental lordosis angle(SLA)of the two groups were compared.Evaluation of fusion between the two groups by Computer Tomography(CT)imaging at 12 months postoperatively.The Visual analog scale(VAS)and Oswestry disability index(ODI)were compared between the two groups.And occurrence of complications was evaluated.Result: The operation time in the unilateral fixation group [(88.06±11.26)min] was significantly shorter than that in the bilateral fixation group[(113.30±8.02)min,P<0.05].There was a significant between-group difference in intraoperative hemorrhage[Unilateral fixation group:(72.78±18.25)ml,Bilateral fixation group:(88.26±15.27)ml;P < 0.05)].Hospital stay did not differ between groups.The medical expenses in the unilateral fixation group(￥ 85229±4340)was less than that in the bilateral fixation group(￥ 98897±5337).In the term of radiography,the DH and SLA at 7 days and 12 months postoperatively were significantly different from those before operation.But there was no significant difference between the two groups in the same follow-up time.The fusion rate at 12 months postoperatively was 88.89% in unilateral fixation group and 95.65% in bilateral fixation group.There was no significant difference between the two groups.In the unilateral fixation group,the VAS were(2.19 ± 0.92)at 7 days postoperatively,(1.61 ± 0.81)at 3 months postoperatively,(1.42 ± 0.77)at 6 months and(1.28 ± 0.71)at 12 months postoperatively.And the VAS were(2.57±1.13)at 7 days postoperatively,(1.74±0.84)at 3 months postoperatively,(1.54±0.75)at 6 months and(1.39±0.73)at 12 months postoperatively,in the bilateral fixation group.In the unilateral fixation group,the ODI after operation were(21.23 ±6.06)%at 7 days,(16.91 ±5.60)% at 3 months,(15.19 ±5.50)% at 6 months,and(14.32 ±5.24)% at 12 months.Those of the bilateral fixation group,were(21.55 ±5.29)% at 7 days,(16.52 ±4.92)% at 3 months,(14.78 ±4.80)% at 6months,and(14.02 ±4.42)% at 12 months.The clinical efficacy evaluation was significantly better than those preoperatively,but no differences between groups were found at any follow-up time point.In terms of complications,there were 1 case of sympathetic chain injury,1 cases of psoas weakness and 2 cases of cage subsidence in the unilateral fixation group.There were 2 case of psoas weakness and 1 case of cage subsidence in another group.The overall incidence of complications was not statistically significant between the two groups(unilateral fixation group:22.22%,bilateral fixation group: 13.04%,P> 0.05).Conclusion: It required less operative time,resulted less iatrogenic trauma and medical expenses that OLIF combined with unilateral pedicle screw fixation in the treatment of single-level lumbar degenerative diseases.And it had comparable effects on radiological and clinical outcomes to that of the bilateral percutaneous pedicle screw fixation.It is worthy of clinical application. |
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