Comparative Analysis of Unilateral versus Bilateral Instrumentation in TLIF for Lumbar Degenerative Disorder: Single Center Large Series
Vigneshwara Badikillaya, Keyur Akbari, Pramod Sudarshan, Hardik Suthar, Muralidharan Venkatesan, Sajan Hegde
Abstract
BACKGROUND: Transforaminal lumbar interbody fusion (TLIF) with bilateral pedicle screw instrumentation is a well-accepted technique in lumbar degenerative disc disorder. Unilateral instrumentation in TLIF has been reported in the literature. This study aims to compare the clinical and radiological outcomes of unilateral and bilateral instrumented TLIF in a selected series of patients. METHODS: We retrospectively analyzed patients operated with unilateral pedicle screw fixation in TLIF (UPSF TLIF) or with bilateral pedicle screw fixation in TLIF (BPSF TLIF) with a minimum of 2 years of follow-up. Patients were evaluated at regular intervals for functional and radiological outcomes. Functional outcome was assessed using the Oswestry disability index (ODI) and visual analog score (VAS) preoperatively and at 6 months, 1 year, and 2 years after surgery. Fusion rates were assessed using Bridwell interbody fusion grading. RESULTS: < .001), favoring UPSF TLIF. CONCLUSIONS: Unilateral pedicle screw fixation in open TLIF is comparable with bilateral pedicle screw fixation in terms of patient-reported clinical outcomes, fusion rates, and complication rates with the additional benefits of less operative time, less blood loss, shorter hospitalization, and less cost in selective cases. LEVEL OF EVIDENCE: 4.