Ipsilateral Pedicle Screw Fixation And Contralateral Translaminar Facet Screw Placement In Conjunction With TLIF: Technical Note

摘要

Transforaminal lumbar interbody fusion (TLIF) has become a widely used method of surgical treatment for a variety of lumbar spinal conditions. Bilateral transpedicular instrumentation is routinely used in conjunction with an interbody cage to provide additional stability. In this technical note, we introduce a hybrid fixation employing pedicle screw construct on the side of TLIF and contralateral translaminar facet screw placement. We also compared the results of hybrid instrumentation with bilateral pedicle screw construct in 40 patients who underwent one or two level TLIF. Sixteen patients were in hybrid fixation group, and 24 in bilateral pedicle screw group. The outcome was evaluated at 6-32 months follow-up. The parameters included radiographic outcome based on evidence of solid union and the clinical outcome was determined by the improvement in Oswestry Disability Index. All patients had radiographic evidence of satisfactory posterolateral fusion at 6 months.None of the patients had any hardware problems at six months. Four patients had transient neuropraxia and no other major complications occurred. Mean preoperative Oswestry Disability Index score of 62 had improved to 24 at last follow up. Minor transient neuropraxia occurred in 4 patients. The average cost of implant including cage and hardware was $9,563 for the hybrid group, and $13,094 for bilateral pedicle screw group. In conclusion, hybrid screwing system minimizes contralateral dissection, eliminates the risk of screw abutment on the adjacent facet joint, and significantly decreases the cost of implants. This hybrid form of fixation is an attractive alternative to standard bilateral pedicle screw fixation. Introduction Transforaminal lumbar interbody fusion (TLIF) has become a well established method of surgical treatment for lumbar spinal disorders such as spondylolisthesis and discogenic back pain. 2,6,7,11Bilateral pedicular posterior spinal screw fixation is usually preferred in conjuction with transforaminal interbody cage and graft placement. 8,10More recently, translaminar facet screws have also been utilized, mostly bilaterally, as a supplement to anterior lumbar interbody fusion. 1,3,4,9It has been reported that biomechanically the translaminar facet screw fixation may provide stability comparable to that of a pedicle screw system. 1 During a TLIF procedure for discogenic back pain, contralateral facet and lamina are usually kept intact. Thus, it is technically possible to insert a translaminar facet screw instead of a pedice screw- rod construct on the side contralateral to TLIF. However, the role of such a hybrid fixation has not been well evaluated. The purpose of this study is to compare the efficacy of a hybrid instrumentation incorporating ipsilateral pedicle screw fixation and contralateral translaminar screw placement with bilateral pedicle screw construct in patients who underwent one or two level TLIF.