Mixed Fixation and Interbody Fusion for Treatment Single-Segment Lower Lumbar Vertebral Disease: Midterm Follow-up Results

Abstract

Objective: To investigate the midterm outcomes of unilateral pedicle screws combined with contralateral gunsight-guided translaminar facet screw fixation and interbody fusion for treatment of single-segment lower lumbar vertebral disease.

Methods: A total of 78 patients with various lower lumbar single-segment vertebral diseases were treated in our department from January 2008 to December 2011. There were 21 males and 57 females, with an average age of 52.5 years, including lumbar disc degeneration (28 cases), local recurrence of lumbar disc herniation (9 cases), huge lumbar disc herniation (11 cases), lumbar disc herniation with spinal stenosis (13 cases), and lumbar degenerative spondylolisthesis (degree I) (17 cases). All patients were treated by unilateral pedicle screws in the median incision combined with contralateral gunsight-guided translaminar facet screw fixation and interbody fusion.

Results: No wound infection or skin necrosis around incision was observed after operation. No leakage of cerebrospinal fluid or nerve injury occurred during and after operation. Excepting 4 cases, 74 cases were followed up for 18-60 months, averaged 33.5 months. All but one patient (98.6%) received interbody fusion. The intervertebral height of the indexed level was well restored and maintained. At final follow-up. During follow-up, there was no screw loosening or pedicle fracture observed. No apparent degeneration of adjacent segments. The mean Japanese Orthopaedic Association (JOA) scores was increased significantly from 12.79 ± 2.12 preoperatively to 25.8 ± 2.87 at the final follow-up.

Conclusion: Unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation and interbody fusion showed good mid-term outcomes in the treatment of single-segment lower lumbar vertebral disease, and can be used as an optimal choice for fixation and fusion of some single-segment lower lumbar vertebral diseases.

Keywords: Fixation; Fusion; Lumbar vertebra; Pedicle screws; Translaminar facet screws.