Comparative efficacy of unilateral transforaminal lumbar interbody fusion with a single-cage and bilateral pedicle internal fixation in the treatment of extreme lateral lumbar disc herniation

[Objective] To compare the short- term clinical effects of unilateral transforaminal lumbar interbody fusion( TLIF) with a single- cage and bilateral pedicle internal fixation in the treatment of extreme lateral lumbar disc herniation. [Methods] We selected patients who were admitted to our hospital with extreme lateral lumbar disc herniation between April 2009 and October 2012. A total of 37 cases were included in this study and randomly divided into two groups according to the surgical intervention: 20 unilateral TLIF cases and 17 bilateral pedicle internal fixation cases. The two groups were compared in terms of surgery duration,intraoperative bleeding volume,duration of bed confinement,and cost of hospitalization. The patients were followed up after the surgery. [Results] The patients in the unilateral fixation group had shorter surgery duration,less bleeding,and lower hospitalization costs than those in the bilateral fixation group,with a statistically significant difference( P 0. 05). The comparison of the visual analog scale( VAS) scores before and three months after surgery showed no significant difference between the groups( P 0. 05); the within- group comparisons indicated that in both groups,the VAS score three months after the surgery was significantly lower than the preoperative VAS score( both P 0. 05). During the postoperative follow- up,primary healing of the surgical incision was observed in all 37 patients; implant loosening,dislocation,and pseudarthrosis were not encountered. [Conclusion] Unilateral pedicle screw fixation combined with single- cage fusion fixed with bilateral pedicle bone grafting fusion shortened surgery duration and reduced bleeding as its short- term effects,and reduced hospitalization costs as its long- term effect. Nevertheless,both surgical methods may be considered safe and effective.