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Unilateral Posterior Stabilization in Adult Spinal Pathologies: Comparative Clinical, Radiological, and Complication

Uzay Erdogan1, Ege Anil Ucar2, Feride Bulgur Balay1

  • 1Bakırköy Prof. Dr. Mazhar Osman Training and Research Hospital, Istanbul 43606, Turkey.

Medicina (Kaunas, Lithuania)
|November 27, 2025
PubMed
Summary

Unilateral spinal stabilization effectively relieves pain, with dynamic systems potentially reducing complications compared to rigid ones, especially in multilevel cases. Both methods offer symptom relief, but dynamic stabilization may better preserve motion and minimize adjacent segment stress.

Keywords:
adjacent segment diseasedynamic stabilizationposterior spinal instrumentationpseudoarthrosistreatment outcomeunilateral fixation

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Area of Science:

  • Spine surgery
  • Orthopedics
  • Neurosurgery

Background:

  • Unilateral spinal stabilization is a less invasive alternative to bilateral fixation for lateralized spinal pathologies.
  • Limited comparative data exists for rigid versus dynamic unilateral systems in multilevel applications.

Purpose of the Study:

  • To compare the clinical efficacy, radiological outcomes, and complication profiles of unilateral rigid stabilization (URS) versus unilateral dynamic stabilization (UDS).
  • To analyze outcomes based on construct length (2, 3, or 4 levels).

Main Methods:

  • Retrospective analysis of 113 patients undergoing unilateral posterior spinal stabilization (2019-2023).
  • Groups: URS (n=41) and UDS (n=72).
  • Outcomes assessed: Visual Analogue Scale (VAS), fusion status, adjacent disc height, foraminal height index, and complication rates (ASD, pseudoarthrosis, screw loosening).

Main Results:

  • Both URS and UDS showed significant VAS improvement (p < 0.001).
  • URS had higher fusion rates (85.37% vs. 27.78%, p < 0.001) but more pseudoarthrosis (39.02% vs. 16.62%).
  • Complication rates, particularly adjacent segment degeneration (ASD), increased with longer constructs (p=0.01), irrespective of stabilization type.

Conclusions:

  • Unilateral stabilization (rigid or dynamic) effectively relieves symptoms with reduced morbidity.
  • Dynamic systems may offer biomechanical advantages, preserving motion and minimizing adjacent segment stress.
  • Dynamic stabilization is recommended for multilevel constructs to optimize outcomes and mitigate long-term complications.