Bilateral Pedicle Screw Fixation Vs Unilateral Pedicle Screw Fixation for Single Level Lateral Lumbar Interbody Fusion: Outcomes, Cost Analysis, and Radiation Exposure.

IF 1.7 Q2 SURGERY

International Journal of Spine Surgery Pub Date : 2025-09-25 DOI:10.14444/8794

Saagar Dhanjani, Timothy Choi, Abdufarrukh Karimov, Kishan S Shah, Micah B Blais, Gregory M Mundis, Ali Bagheri, Behrooz A Akbarnia, Robert K Eastlack

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引用次数: 0

Abstract

Background: This study aims to determine whether single-level lateral lumbar interbody fusion (LLIF) with unilateral pedicle screw fixation (UPSF) might offer advantages over bilateral pedicle screw fixation (BPSF) in terms of radiation emission, cost, and outcomes.

Methods: The records of 101 patients who underwent single-level LLIF with percutaneous pedicle screw fixation from September 2017 to August 2024 were analyzed. Patients were divided into 2 groups: 42 with UPSF and 59 with BPSF. Demographic data, social history, comorbidities, surgical characteristics, costs (based on manufacturer prices), and radiation metrics (radiation emitted, fluoroscopy time, number of images, and magnification mode used) were collected. Clinical outcomes were assessed using the Numeric Rating Scale (NRS), the Oswestry Disability Index, and procedure satisfaction, while radiographic evaluation employed a novel fusion classification system.

Results: There were no significant differences in age, body mass index, social history, comorbidities, or operative level. However, the BPSF group included significantly more women (P = 0.002) and a higher proportion of spondylolisthesis cases (P < 0.001). Oswestry Disability Index and NRS scores were similar, except for greater improvements in NRS back pain at 1 year in the BPSF group (-4.0 vs -1.75, P = 0.008). While the total fluoroscopy time, number of images, and Mag 1 usage were greater in the BPSF group (all P < 0.001), the average radiation emitted did not significantly differ (39.38 milligray for UPSF vs 50.75 milligray for BPSF, P = 0.211). Fusion grades were comparable (P = 0.478), and UPSF costs were 27.7% lower.

Conclusions: Our study found that when used according to clinical indications, UPSF results in similar radiation emission and radiographic outcomes, while being 27.7% less expensive than BPSF for single-level LLIF. Additionally, while BPSF was associated with greater improvement in 1 year NRS back scores, no other significant differences in patient-reported outcome measures were observed between the 2 groups.

Clinical relevance: This study provides clinically relevant insights for selecting between UPSF and BPSF in single-level LLIF when both are considered appropriate.

Level of evidence: 3:

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双侧椎弓根螺钉固定与单侧椎弓根螺钉固定治疗单节段侧腰椎椎体间融合术：结果、成本分析和辐射暴露。

背景：本研究旨在确定单节段外侧腰椎椎体间融合术（LLIF）联合单侧椎弓根螺钉固定（UPSF）是否在放射、成本和结果方面优于双侧椎弓根螺钉固定（BPSF）。方法：分析2017年9月至2024年8月101例经皮经椎弓根螺钉内固定单节段LLIF患者的临床资料。将患者分为2组：UPSF组42例，BPSF组59例。收集了人口统计数据、社会历史、合并症、手术特征、成本（基于制造商价格）和辐射指标（辐射发射、透视时间、图像数量和使用的放大模式）。临床结果采用数字评定量表（NRS）、Oswestry残疾指数和手术满意度进行评估，而放射学评估采用一种新的融合分类系统。结果：两组患者在年龄、体重指数、社会病史、合并症、手术水平等方面无显著差异。然而，BPSF组包括更多的女性（P = 0.002）和更高比例的脊柱滑脱病例（P < 0.001）。Oswestry残疾指数和NRS评分相似，除了BPSF组1年NRS背痛的改善更大（-4.0 vs -1.75, P = 0.008）。虽然BPSF组的总透视时间、图像数量和1级显像使用更大（均P < 0.001），但平均放射量没有显著差异（UPSF组为39.38毫克，BPSF组为50.75毫克，P = 0.211）。融合等级具有可比性（P = 0.478）， UPSF成本降低27.7%。结论：我们的研究发现，当根据临床适应症使用UPSF时，UPSF的辐射发射和放射学结果相似，而对于单级别LLIF， UPSF的费用比BPSF低27.7%。此外，虽然BPSF与1年NRS背部评分的更大改善相关，但在患者报告的结果测量中，两组之间没有观察到其他显著差异。临床相关性：本研究为单水平LLIF患者在UPSF和BPSF之间的选择提供了临床相关的见解。证据等级：3；

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来源期刊

International Journal of Spine Surgery Medicine-Surgery

CiteScore

3.10

自引率

0.00%

发文量

162

期刊介绍： The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.