• Alan T Villavicencio, Benjamin J Serxner, Alexander Mason, E Lee Nelson, Sharad Rajpal, Nathan Faes, and Sigita Burneikiene.
• Boulder Neurosurgical Associates, Boulder, Colorado, USA; Justin Parker Neurological Institute, Boulder, Colorado, USA.
• World Neurosurg. 2015 Apr 1;83(4):553-9.

BackgroundTransforaminal lumbar interbody fusion with bilateral segmental pedicle screw (PS) fixation is a widely used and well-recognized technique that provides fixation and load-bearing capacity, while restoring morphometric spine parameters and relieving symptoms in patients with degenerative disc disease. A supplemental interspinous process fixation plate (ISFP) as an adjunct to unilateral PS fixation allows for reduced invasiveness of this technique compared with bilateral PS placement. The biomechanical comparison results have been previously reported, but the significance of these findings has not been studied in clinical settings.MethodsA prospective cohort study with a supplemental retrospective chart review and radiographic analysis was performed. Patients were divided into 2 groups: bilateral PS fixation (n = 75) or unilateral PS fixation + ISFP (n = 96). Lateral lumbar standing radiographs were obtained for preoperative and postoperative foraminal height (FH), disc height, segmental sagittal alignment, and lumbar sagittal alignment measurements. Standardized questionnaires were used to compare postoperative clinical outcomes.ResultsThe estimated blood loss, duration of procedure, and length of hospital stay were significantly lower for 1-level and 2-level procedures in the unilateral PS + ISFP group. A statistically significant mean disc height increase was observed in both groups. Regardless of the disc height increase, a statistically significant FH loss was detected in the bilateral PS group (from 17.1 mm to 16.3 mm; 4.7% loss; P = 0.04) compared with FH height loss in the unilateral PS + ISFP group that was not statistically significant (from 19.0 mm to 18.4 mm; 3.2% loss; P = 0.1). The analysis of segmental sagittal alignment, lumbar sagittal alignment, clinical outcomes, and fusion rates did not demonstrate any statistically significant differences.ConclusionsSignificantly reduced surgical invasiveness was associated with unilateral PS + ISFP fixation, which represents the major advantage of this technique. Unilateral fixation was also associated with a slightly lower reduction in FH and was equally effective as bilateral PS fixation in regard to fusion rates, clinical outcomes, and other radiographic outcomes studied.Copyright © 2015 Elsevier Inc. All rights reserved.

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