Comparison of Unilateral versus Bilateral Instrumented Transforaminal Lumbar Interbody Fusion in Lumbar Degenerative Diseases: A Minimum of 5-Year Follow-Up
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Surgical Procedures
2.3. Data Collection and Outcome Assessment
2.4. Statistical Analysis
3. Results
3.1. Patients and Characteristics
3.2. Comparison of Characteristics and Perioperative Information between Two Groups
3.3. Comparison of Clinical and Radiological Outcomes between Two Groups
3.4. Intra- and Inter-Observer Reliabilities
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Score | |
---|---|
Intermittent claudication | |
Normal | 3 |
Able to walk > 500 m but with pain, tingling, and/or muscle weakness | 2 |
Able to walk > 500 m because of pain, tingling, and/or muscle weakness | 1 |
Able to walk > 100 m because of pain, tingling, and/or muscle weakness | 0 |
Kirkaldy–Willis criteria | |
The patient has returned to their normal work and other activities with little or no complaints | Excellent |
The patient has returned to their normal work but may have some restriction in other activities and may on occasion after heavy work have recurrent back pain requiring rest for a few days | Good |
The patient has to reduce their working capacity, take a lighter job or work part-time, and occasionally have a recurrence of pain requiring absence from work for 1–2 weeks, once or twice a year | Fair |
The patient does not return to work | Poor |
UITLIF (n = 63) | BITLIF (n = 111) | p-Value | |
---|---|---|---|
Age (yrs) | 68 (62, 71) | 61 (55, 68) | <0.001 *,† |
Sex, n (%) | 0.145 ‡ | ||
Female | 36 (57.1) | 77 (69.4) | |
Male | 27 (42.9) | 34 (30.6) | |
BMD, T-score | −2.66 (−3.41, −1.83) | −2.56 (−3.17, −1.59) | 0.259 † |
Fused segment, n (%) | 0.859 § | ||
L2-3 | 1 (1.6) | 2 (1.8) | |
L3-4 | 6 (9.5) | 8 (7.2) | |
L4-5 | 40 (63.5) | 77 (69.4) | |
L5-S1 | 16 (25.4) | 24 (21.6) | |
Diagnosis, n (%) | 0.012 *,‡ | ||
Degenerative spondylolisthesis | 17 (27.0) | 74 (66.7) | |
Spondylolytic spondylolisthesis | 3 (4.8) | 22 (19.8) | |
Spinal stenosis without spondylolisthesis or instability | 43 (68.3) | 15 (13.5) | |
Operation time (min) | 185.0 (170.0, 210.0) | 225.0 (200.0, 265.0) | <0.001 *,† |
EBL (mL) | 300.0 (250.0, 500.0) | 550.0 (400.0, 800.0) | <0.001 *,† |
Follow-up (months) | 82.0 (66.0, 98.0) | 85.0 (72.0, 85.0) | 0.252 † |
UITLIF (n = 63) | BITLIF (n = 111) | p-Value | |
---|---|---|---|
Radiological outcomes | |||
LCA (°) | |||
Preoperative | 2.09 (5.53, 5.53) | 1.38 (0.63, 3.87) | 0.125 † |
Postoperative | 1.03 (1.70, 1.70) | 0.97 (0.60, 1.86) | 0.344 † |
Last follow-up | 1.74 (3.34, 3.34) | 1.27 (0.64, 2.37) | 0.201 † |
Interval change | 0.73 (1.48, 1.48) | 0.73 (0.39, 1.37) | 0.687 † |
LA (°) | |||
Preoperative, mean ± SD | 38.98 ± 12.88 | 42.41 ± 14.16 | 0.114 ‡ |
Postoperative, mean ± SD | 41.67 ± 10.28 | 43.91 ± 10.79 | 0.183 ‡ |
Last follow-up, mean ± SD | 38.48 ± 12.82 | 42.25 ± 13.6 | 0.075 ‡ |
Interval change | 4.01 (6.97, 6.97) | 3.93 (1.71, 7.74) | 0.701 † |
COB (mm) | |||
Preoperative | 5.98 (10.9, 10.9) | 5.47 (2.96, 9.20) | 0.823 † |
Postoperative | 3.80 (6.97, 6.97) | 4.72 (1.84, 8.10) | 0.234 † |
Last follow-up | 4.02 (8.04, 8.04) | 4.94 (2.20, 8.81) | 0.195 † |
Interval change | 3.86 (6.52, 6.52) | 4.54 (2.01, 6.86) | 0.367 † |
Clinical outcomes | |||
Intermittent claudication scores | |||
Preoperative | 1 (0, 1) | 1 (0,1) | 0.039 *,† |
1 year postoperative | 2 (2, 2) | 2 (2, 2) | 0.495† |
K-W criteria 1 year postoperative, n (%) | 0.707 § | ||
Excellent/Good | 49 (77.8) | 89 (80.2) | |
Fair/Poor | 14 (22.2) | 22 (19.8) |
Effect | Num DF | Den DF | F Value | p-Value |
---|---|---|---|---|
Operation type | 1 | 172 | 3.37 | 0.068 |
Time | 1 | 172 | 514.7 | <0.001 * |
Operation type × Time | 1 | 172 | 2.18 | 0.1415 |
Variable | Effect | Num DF | Den DF | F Value | p-Value |
---|---|---|---|---|---|
LCA | Operation type | 1 | 157 | 0.187 | 0.666 |
Preoperative LCA | 1 | 157 | 1.089 | 0.298 | |
Postoperative LCA | 1 | 157 | 2.124 | 0.147 | |
Sex | 1 | 157 | 0.661 | 0.417 | |
Age | 1 | 157 | 0.021 | 0.884 | |
Surgeon | 4 | 157 | 1.293 | 0.275 | |
Fused segment | 3 | 157 | 1.434 | 0.235 | |
Subsidence | 1 | 157 | 0.027 | 0.870 | |
Diagnosis | 2 | 157 | 0.478 | 0.621 | |
BMD | 1 | 157 | 0.000 | 0.988 | |
COB | Operation type | 1 | 157 | 0.958 | 0.329 |
Preoperative COB | 1 | 157 | <0.001 | 0.992 | |
Postoperative COB | 1 | 157 | 18.586 | <0.001 * | |
Sex | 1 | 157 | 0.002 | 0.966 | |
Age | 3 | 157 | 1.897 | 0.170 | |
Surgeon | 4 | 157 | 0.143 | 0.966 | |
Fused segment | 3 | 157 | 0.950 | 0.418 | |
Subsidence | 1 | 157 | 2.972 | 0.087 | |
Diagnosis | 2 | 157 | 0.133 | 0.875 | |
BMD | 1 | 157 | 1.461 | 0.229 | |
LA | Operation type | 1 | 157 | 0.339 | 0.561 |
Preoperative LA | 1 | 157 | 3.965 | 0.048 * | |
Postoperative LA | 1 | 157 | 0.983 | 0.323 | |
Sex | 1 | 157 | 0.958 | 0.329 | |
Age | 1 | 157 | 0.027 | 0.870 | |
Surgeon | 4 | 157 | 0.857 | 0.491 | |
Fused segment | 3 | 157 | 0.666 | 0.574 | |
Subsidence | 1 | 157 | 1.690 | 0.196 | |
Diagnosis | 2 | 157 | 1.108 | 0.333 | |
BMD | 1 | 157 | 0.793 | 0.375 |
UITLIF (n = 63) | BITLIF (n = 111) | p-Value | |
---|---|---|---|
Cage subsidence, n (%) | 8 (12.7) | 8 (7.2) | 0.351 * |
Pseudarthrosis, n (%) | 3 (4.8) | 2 (1.8) | 0.354 † |
Metal failure, n (%) | 2 (3.2) | 4 (3.6) | 1.000 † |
ASD, n (%) | 34 (54.0) | 58 (52.3) | 0.952 * |
Postoperative infection, n (%) | 2 (3.2) | 5 (4.5) | 1.000 † |
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Park, S.C.; Bae, J.S.; Jung, S.O.; Sung, K.-H.; Chung, H.-J. Comparison of Unilateral versus Bilateral Instrumented Transforaminal Lumbar Interbody Fusion in Lumbar Degenerative Diseases: A Minimum of 5-Year Follow-Up. Medicina 2023, 59, 1898. https://doi.org/10.3390/medicina59111898
Park SC, Bae JS, Jung SO, Sung K-H, Chung H-J. Comparison of Unilateral versus Bilateral Instrumented Transforaminal Lumbar Interbody Fusion in Lumbar Degenerative Diseases: A Minimum of 5-Year Follow-Up. Medicina. 2023; 59(11):1898. https://doi.org/10.3390/medicina59111898
Chicago/Turabian StylePark, Sung Cheol, Jae Seong Bae, Seon Ok Jung, Kyeong-Hoon Sung, and Hoon-Jae Chung. 2023. "Comparison of Unilateral versus Bilateral Instrumented Transforaminal Lumbar Interbody Fusion in Lumbar Degenerative Diseases: A Minimum of 5-Year Follow-Up" Medicina 59, no. 11: 1898. https://doi.org/10.3390/medicina59111898