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Unilateral Pedicle Screw Fixation is Associated with Reduced Cost and Similar Outcomes in Selected Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion for L4-5 Degenerative Spondylolisthesis.

Eliades P, Rahal JP, Herrick DB, Corliss BM, Riesenburger R, Hwang S, Kryzanski JT - Cureus (2015)

Bottom Line: Lumbar fusion surgeries, including the TLIF procedure, have been shown to be an effective treatment for leg and low back pain caused by degenerative spondylolisthesis. Some studies have shown TLIF surgeries to be cost-effective, but there is still a paucity of data and no consensus. Unilateral TLIFs can provide the same benefits as bilateral TLIFs, but come with additional benefits of a less invasive surgery.Most patients reported good or excellent results, and there were no significant differences between the cohorts with regard to clinical outcome.Hospital cost was significantly lower in the unilateral cohort, and hardware savings accounted for only part of the difference.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Tufts University School of Medicine ; Wellman Center for Photomedicine and Department of Dermatology, Massachusetts General Hospital/ Harvard Medical School.

ABSTRACT

Study design: Retrospective study of 24 patients who underwent either a bilateral or unilateral TLIF procedure for the treatment of degenerative spondylolisthesis.

Objective: To analyze differences in cost and outcome between patients undergoing minimally invasive transforaminal lumbar interbody fusion (mi-TLIF) with unilateral or bilateral pedicle screw fixation for L4-5 degenerative spondylolisthesis.

Summary of background data: Lumbar fusion surgeries, including the TLIF procedure, have been shown to be an effective treatment for leg and low back pain caused by degenerative spondylolisthesis. Some studies have shown TLIF surgeries to be cost-effective, but there is still a paucity of data and no consensus. Unilateral TLIFs can provide the same benefits as bilateral TLIFs, but come with additional benefits of a less invasive surgery.

Methods: We retrospectively analyzed a consecutive series of patients with L4-5 degenerative stenosis and spondylolisthesis who either received a unilateral or bilateral mi-TLIF, paying particular attention to hospital cost and clinical outcome. Of the 33 patients eligible for analysis, we were able to obtain appropriate clinical and radiographic follow-up data on 24 patients (72.7%), 14 patients who underwent unilateral fixation, and 10 patients who underwent bilateral fixation.

Results: The cohorts were similar with regard to age, comorbidities, and demographics. Most patients reported good or excellent results, and there were no significant differences between the cohorts with regard to clinical outcome. There was one interbody graft extrusion in the unilateral cohort that required explantation, but no other hardware failures. Hospital cost was significantly lower in the unilateral cohort, and hardware savings accounted for only part of the difference.

Conclusion: Unilateral pedicle screw fixation is an acceptable surgical strategy in patients with stable L4-5 degenerative spondylolisthesis undergoing mi-TLIF. In our series, unilateral fixation led to significant hospital cost savings without compromising clinical or radiographic outcomes.

No MeSH data available.


Related in: MedlinePlus

Interbody Graft Extrusion in a Unilaterally-Fixated Patient with an Abnormal Pedicle(A, B) Preoperative flexion (A) and extension (B) radiographs demonstrating anterolisthesis which increases >3mm in flexion. (C) Axial computed tomography through L5 demonstrating a vascular or neural structure within the left L5 pedicle.  (D) 3-month follow-up lateral radiograph demonstrating posterior graft migration.
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FIG1: Interbody Graft Extrusion in a Unilaterally-Fixated Patient with an Abnormal Pedicle(A, B) Preoperative flexion (A) and extension (B) radiographs demonstrating anterolisthesis which increases >3mm in flexion. (C) Axial computed tomography through L5 demonstrating a vascular or neural structure within the left L5 pedicle.  (D) 3-month follow-up lateral radiograph demonstrating posterior graft migration.

Mentions: Of 24 patients, 14 underwent unilateral mi-TLIF, and 10 underwent bilateral mi-TLIF. The patient demographics and comorbidities are provided in Table 2. There were no statistically significant differences between the two cohorts with regards to age or comorbidity. The average length of stay was 4.3 ± 2.1 days for the unilateral cohort, and 4.2 ± 1.0 days (P = 0.90) for the bilateral cohort. One patient in the unilateral cohort suffered postoperative atrial fibrillation that resulted in an extended length of stay of 10 days, an outlier that increased the average length of stay by 0.5 days. This case was also the only perioperative complication in the cohort; no patients in either cohort experienced postoperative radiculitis, venous thrombosis, pneumonia, myocardial infarction, cerebrospinal fluid leak, or surgical site infection. One patient in the unilateral cohort had interbody graft extrusion several months postoperatively requiring explantation. Notably, this patient was considered unstable given the findings of significant translation and angulation on preoperative dynamic imaging studies (Figures 1A, 1B). Bilateral instrumentation was not performed in this case because of a dysmorphic L5 pedicle that appeared to contain a neural or vascular structure (Figure 1C). On three-month follow-up, radiography demonstrated posterior migration of the graft (Figure 1D), which was subsequently explanted.


Unilateral Pedicle Screw Fixation is Associated with Reduced Cost and Similar Outcomes in Selected Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion for L4-5 Degenerative Spondylolisthesis.

Eliades P, Rahal JP, Herrick DB, Corliss BM, Riesenburger R, Hwang S, Kryzanski JT - Cureus (2015)

Interbody Graft Extrusion in a Unilaterally-Fixated Patient with an Abnormal Pedicle(A, B) Preoperative flexion (A) and extension (B) radiographs demonstrating anterolisthesis which increases >3mm in flexion. (C) Axial computed tomography through L5 demonstrating a vascular or neural structure within the left L5 pedicle.  (D) 3-month follow-up lateral radiograph demonstrating posterior graft migration.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494589&req=5

FIG1: Interbody Graft Extrusion in a Unilaterally-Fixated Patient with an Abnormal Pedicle(A, B) Preoperative flexion (A) and extension (B) radiographs demonstrating anterolisthesis which increases >3mm in flexion. (C) Axial computed tomography through L5 demonstrating a vascular or neural structure within the left L5 pedicle.  (D) 3-month follow-up lateral radiograph demonstrating posterior graft migration.
Mentions: Of 24 patients, 14 underwent unilateral mi-TLIF, and 10 underwent bilateral mi-TLIF. The patient demographics and comorbidities are provided in Table 2. There were no statistically significant differences between the two cohorts with regards to age or comorbidity. The average length of stay was 4.3 ± 2.1 days for the unilateral cohort, and 4.2 ± 1.0 days (P = 0.90) for the bilateral cohort. One patient in the unilateral cohort suffered postoperative atrial fibrillation that resulted in an extended length of stay of 10 days, an outlier that increased the average length of stay by 0.5 days. This case was also the only perioperative complication in the cohort; no patients in either cohort experienced postoperative radiculitis, venous thrombosis, pneumonia, myocardial infarction, cerebrospinal fluid leak, or surgical site infection. One patient in the unilateral cohort had interbody graft extrusion several months postoperatively requiring explantation. Notably, this patient was considered unstable given the findings of significant translation and angulation on preoperative dynamic imaging studies (Figures 1A, 1B). Bilateral instrumentation was not performed in this case because of a dysmorphic L5 pedicle that appeared to contain a neural or vascular structure (Figure 1C). On three-month follow-up, radiography demonstrated posterior migration of the graft (Figure 1D), which was subsequently explanted.

Bottom Line: Lumbar fusion surgeries, including the TLIF procedure, have been shown to be an effective treatment for leg and low back pain caused by degenerative spondylolisthesis. Some studies have shown TLIF surgeries to be cost-effective, but there is still a paucity of data and no consensus. Unilateral TLIFs can provide the same benefits as bilateral TLIFs, but come with additional benefits of a less invasive surgery.Most patients reported good or excellent results, and there were no significant differences between the cohorts with regard to clinical outcome.Hospital cost was significantly lower in the unilateral cohort, and hardware savings accounted for only part of the difference.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Tufts University School of Medicine ; Wellman Center for Photomedicine and Department of Dermatology, Massachusetts General Hospital/ Harvard Medical School.

ABSTRACT

Study design: Retrospective study of 24 patients who underwent either a bilateral or unilateral TLIF procedure for the treatment of degenerative spondylolisthesis.

Objective: To analyze differences in cost and outcome between patients undergoing minimally invasive transforaminal lumbar interbody fusion (mi-TLIF) with unilateral or bilateral pedicle screw fixation for L4-5 degenerative spondylolisthesis.

Summary of background data: Lumbar fusion surgeries, including the TLIF procedure, have been shown to be an effective treatment for leg and low back pain caused by degenerative spondylolisthesis. Some studies have shown TLIF surgeries to be cost-effective, but there is still a paucity of data and no consensus. Unilateral TLIFs can provide the same benefits as bilateral TLIFs, but come with additional benefits of a less invasive surgery.

Methods: We retrospectively analyzed a consecutive series of patients with L4-5 degenerative stenosis and spondylolisthesis who either received a unilateral or bilateral mi-TLIF, paying particular attention to hospital cost and clinical outcome. Of the 33 patients eligible for analysis, we were able to obtain appropriate clinical and radiographic follow-up data on 24 patients (72.7%), 14 patients who underwent unilateral fixation, and 10 patients who underwent bilateral fixation.

Results: The cohorts were similar with regard to age, comorbidities, and demographics. Most patients reported good or excellent results, and there were no significant differences between the cohorts with regard to clinical outcome. There was one interbody graft extrusion in the unilateral cohort that required explantation, but no other hardware failures. Hospital cost was significantly lower in the unilateral cohort, and hardware savings accounted for only part of the difference.

Conclusion: Unilateral pedicle screw fixation is an acceptable surgical strategy in patients with stable L4-5 degenerative spondylolisthesis undergoing mi-TLIF. In our series, unilateral fixation led to significant hospital cost savings without compromising clinical or radiographic outcomes.

No MeSH data available.


Related in: MedlinePlus