Background Lumbar interbody fusion procedure is a recognized surgical technique in management of a variety of lumbar pathologies including recurrent lumbar disc prolapse. Interbody fusion augmented by pedicle screw fixation has been considered to improve fusion rates and clinical outcomes. Interbody fusion is commonly associated with better fusion potentials through applying the bone graft in the load bearing, vascular position of the anterior, and middle spinal columns. However, it still remains unknown whether interbody fusion with unilateral pedicle screw fixation (UPSF) is superior to that with bilateral pedicle screw fixation (BPSF). Aim of the work The aim of this study is to evaluate the efficacy and safety of unilateral versus bilateral pedicle screw fixation associated with interbody fusion for the management of single level unilateral recurrent lumbar disc prolapse as regard the clinical and biomechanical results, operation time, intraoperative blood loss, and postoperative stay. Material and methods This observational prospective comparative study of the two groups who were operated either unilateral (group A /15 patients) or bilateral (group B/15 patients) pedicle screw fixation with interbody fusion was done. Patients were followed up for 1, 6, ad 12 months. Results Significant improvement in functional outcome of the two groups was noted compared to preoperatively, except in early postoperative period where the back VAS and ODI in the unilateral group was better than bilateral group. However, on further follow up, no significant difference was noticed. There was no significant difference comparing fusion rate, complication rate, and duration of hospital stay between the two groups at postoperative follow-up. There was significantly less blood loss, and significantly shorter operation time in the unilateral PS fixation group as compared with the bilateral PS fixation group in our study. Conclusion Our study suggested that TLIF with unilateral PS fixation was as safe and effective as that with bilateral PS fixation for the management of recurrent single level lumbar disc prolapse; it showed better clinical outcome scores of ODI and back VAS, and a significant reduction of the intraoperative blood loss as well as the operation time, without significant differences considering fusion rate, complication rate, and duration of hospital stay between the two groups at postoperative follow-up. However, BPSF with TLIF likely causes more degeneration at the cranial adjacent segment compared with UPSF techniques. Nevertheless, the long-term follow up is required to demonstrate the impact of these findings.

中文翻译：

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单节段复发性单侧腰椎间盘突出症的治疗：单侧与双侧椎弓根螺钉固定与椎间融合

背景腰椎椎间融合手术是一种公认​​的手术技术，可用于治疗包括复发性腰椎间盘突出症在内的多种腰椎疾病。通过椎弓根螺钉固定增强的椎间融合被认为可以提高融合率和临床结果。通过在承重、前、中脊柱的血管位置中应用骨移植物，椎间融合通常与更好的融合潜力相关。然而，单侧椎弓根螺钉固定（UPSF）的椎间融合是否优于双侧椎弓根螺钉固定（BPSF）仍然未知。工作目的 本研究的目的是评估单侧与双侧椎弓根螺钉固定联合椎间融合治疗单节段单侧复发性腰椎间盘突出症的疗效和安全性，包括临床和生物力学结果、手术时间、术中失血量和术后住院时间。材料和方法 对接受单侧（A 组/15 名患者）或双侧（B 组/15 名患者）椎弓根螺钉固定和椎间融合术的两组进行了这项观察性前瞻性比较研究。对患者进行了 1、6、12 个月的随访。结果 与术前相比，两组患者的功能预后均有显着改善，除术后早期单侧组背部VAS和ODI优于双侧组外。然而，在进一步的随访中，没有注意到显着差异。术后随访时两组融合率、并发症发生率、住院时间比较无显着差异。在我们的研究中，与双侧 PS 固定组相比，单侧 PS 固定组的失血量显着减少，手术时间显着缩短。结论 我们的研究表明，单侧 PS 固定 TLIF 与双侧 PS 固定治疗复发性单节段腰椎间盘突出症一样安全有效；它显示出更好的 ODI 和背部 VAS 的临床结果评分，术中失血量和手术时间显着减少，术后随访时两组在融合率、并发症发生率、住院时间等方面无显着差异。然而，与 UPSF 技术相比，带有 TLIF 的 BPSF 可能会在颅骨相邻节段引起更多的退化。然而，需要长期随访来证明这些发现的影响。