Abstract
STUDY DESIGN: This retrospective study compared unilateral pedicle screw combined with contralateral translaminar facet joint screw (UPS+TFS) fixation with bilateral pedicle screw (BPS) fixation in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for single-segment lumbar degenerative disease. OBJECTIVE: To assess the long-term clinical efficacy of UPS+TFS fixation and BPS fixation in MIS-TLIF. SUMMARY OF BACKGROUND DATA: Limited research exists on the long-term clinical outcomes of UPS+TFS fixation in MIS-TLIF. This study addresses this gap by comparing UPS+TFS with the more common BPS fixation technique. MATERIALS AND METHODS: A retrospective analysis of 151 patients with single-segment lumbar degenerative disease treated with MIS-TLIF at Chinese PLA General Hospital (March 2011-December 2012) was conducted. Propensity score matching (1:1) resulted in 32 patients per group (UPS+TFS and BPS). Basic demographic characteristics, preoperative functional scores, perioperative indicators, and postoperative complications were compared between the groups. Lumbar and leg visual analog scale (VAS), Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) scores up to 10 years postoperatively were also compared. The surgical outcomes of both groups were evaluated using the MacNab criteria at the final follow-up. RESULTS: The UPS+TFS group had significantly lower lumbar VAS scores at three months postoperatively ( P <0.05) with less intraoperative blood loss, shorter surgery time, and reduced hospital stay compared with the BPS group ( P <0.05). No significant differences were found in the JOA or ODI scores between the two groups at three months and 1, 3, 5, and 10 years postsurgery ( P >0.05). CONCLUSION: UPS+TFS and BPS fixation during MIS-TLIF can achieve favorable clinical outcomes with no difference in long-term clinical efficacy. UPS+TFS demonstrates perioperative advantages such as reduced intraoperative blood loss, shorter operation time, reduced postoperative hospital stay, and less iatrogenic injury. Therefore, MIS-TLIF with UPS+TFS fixation is a reliable treatment for single-segment lumbar degenerative disease.