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العنوان
Unilateral versus bilateral Pedicle Screw Fixation associated with interbody fusion in degenerative Lumbar spine diseases /
المؤلف
Khalil,Mostafa Khalil Ghobashi.
هيئة الاعداد
باحث / Mostafa Khalil Ghobashi Khalil
مشرف / Essam Eldein Abdel Rahman Emara
مشرف / Sherif Hashem Morad
مشرف / Ahmed Roshdy Farghaly
تاريخ النشر
2019
عدد الصفحات
197p.:
اللغة
الإنجليزية
الدرجة
الدكتوراه
التخصص
جراحة
تاريخ الإجازة
1/1/2019
مكان الإجازة
جامعة عين شمس - كلية الطب - جراحة المخ و الاعصاب
الفهرس
Only 14 pages are availabe for public view

from 197

from 197

Abstract

Surgical procedures that include both posterolateral and interbody fusion have demonstrated high fusion rates and good clinical results. These procedures have distinct advantages including anterior column load sharing, large surface areas for fusion, restoration of a normal sagittal profile, and the achievement of passive foraminal decompression.
Lumbar interbody fusion is a recognized surgical technique in treatment of degenerative lumbar instability. Interbody fusion supplemented with pedicle screw fixation has several advantages over posterolateral fusion and has been advocated to improve fusion rates and clinical outcomes. Interbody fusion places the bone graft in the loadbearing position of the anterior and middle spinal columns thereby enhancing the potential for fusion. In addition, the interbody space has more vascularity than the posterolateral space, also increasing the potential for a solid fusion mass to form. Bilateral PS fixation after lumbar interbody fusion is accepted as a standard procedure. Providing rigid fixation, bilateral PS fixation has a great biomechanical stability and clinical benefits. However, the rigidity of bilateral PS fixation can lead to device-related osteoporosis of the vertebrae and makes the adjacent segment prone to load- and motion-induced degeneration. To achieve optimal biomechanical conditions in the fused segment and minimize adverse effects in the adjacent levels caused by instrumentation, the use of less rigid systems of fixation has been advocated. Some recent clinical and biomechanical studies on the suitability of unilateral PS fixation have demonstrated that a reliable fusion with fewer pedicle screws can be achieved. Therefore, the use of unilateral or bilateral PS fixation remains a matter of debate. No differences were observed between the two groups with respect to demographic data. The patients of the two groups had significant improvement in functional outcome compared to preoperatively, except in early postoperative VAS back and ODI in unilateral group which is better than bilateral group. However, no significant difference noticed in the further follow up. 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, shorter postoperative pain killer use and significantly shorter operation time in the unilateral PS fixation group as compared with the bilateral PS fixation group in our study. Unilateral PS fixation dissects soft tissue and insert pedicle screws only on one side and therefore it takes less time and decreases blood loss. Moreover, less soft tissue dissection may allow for early recovery.