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《The Journal of Traditional Chinese Orthopedics and Traumatology》 2015-01
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Effect of unilateral versus bilateral fixation with pedicle screws on adjacent segment degeneration in patients with lumbar disc herniation

LIN Bin;LI Qiusheng;HE Yong;GUO Zhimin;The 175th Hospital of PLA/The Affiliated Dongnan Hospital of Xiamen University;  
Objective: To explore the effect of unilateral fixation and bilateral fixation with pedicle screws on adjacent segment degeneration( ASD) in patients with lumbar disc herniation( LDH) and compare the clinical curative effects between the two kinds of surgery. Methods: The medical records of 101 patients with LDH( L4- 5) were analyzed retrospectively. The patients consisted of 40 males and 61 females,and ranged in age from 18 to 62 years( Median = 49 yrs). The course of disease ranged from 2 to 9 years( Median = 5 yrs). The unilateral fixation was performed in 42 patients and bilateral fixation was performed in 59 patients. Lumbar spine function restoration and postoperative adjacent segment degeneration were reviewed and compared between the 2 groups. Results: There was no statistical difference in incidence of degeneration of the first cephalic adjacent segment and caudal adjacent segment between the 2 groups( χ2= 2. 721,P = 0. 099),while the bilateral fixation group was higher in incidence of degeneration of the 2nd cephalic adjacent segment compared to the unilateral fixation group( χ2=5. 140,P = 0. 023). There was statistical differences in Oswestry Disability Index( ODI) between the 2 groups,and the unilateral fixation group surpassed the bilateral fixation group in the lumbar function recovery( 25. 6 +/- 5. 9 vs 28. 4 +/- 5. 2 points; t =- 2. 503,P = 0. 014). Conclusion: For patients with single segment LDH who are treated with lumbar decompression in posterior access and pedicle screw internal fixation and intervertebral fusion,the incidence of ASD of unilateral fixation is lower than that of bilateral fixation,especially for the 2nd cephalic adjacent segment. Furthermore,unilateral fixation with pedicle screws is more conducive to lumbar function recovery.
【CateGory Index】: R687.3
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