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Bilateral versus Unilateral Decompression in Single-Level Transforaminal Lumbar Interbody Fusion for Degenerative
Lu-Ming Nong1, Jian-Jian Yin1, Gong-Ming Gao1
1Department of Orthopedics, Third Affiliated Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou, Jiangsu Province, China.
World Neurosurgery
|January 9, 2026
Summary
Preemptive bilateral decompression (BAD) in single-level TLIF for grade I spondylolisthesis improves early recovery and reduces neural events compared to unilateral decompression (UAD). This approach enhances patient outcomes without increasing risks.
Area of Science:
- Spine surgery
- Neurosurgery
- Orthopedic surgery
Background:
- Degenerative spondylolisthesis is a common spinal condition.
- Transforaminal lumbar interbody fusion (TLIF) is a surgical treatment.
- Early neural complications and recovery are key concerns in TLIF.
Purpose of the Study:
- To compare preemptive bilateral decompression (BAD) with unilateral approach decompression (UAD).
- To assess the impact of BAD versus UAD on early neural events.
- To evaluate the effect of BAD versus UAD on very-early recovery after single-level TLIF for Meyerding grade I degenerative spondylolisthesis.
Main Methods:
- Retrospective single-center study from 2015-2022 with over 24-month follow-up.
- Patients were allocated to UAD (2015-2018) or BAD (2019-2022) based on practice evolution.
- Primary endpoints included very-early recovery (VAS, ODI, JOA at POD1/POD7) and neural complications.
Main Results:
- BAD group (n=106) had longer operative time than UAD group (n=102).
- BAD significantly improved very-early recovery (VAS POD7) and reduced neural events (EPRP, contralateral aggravation).
- Two-year JOA recovery rates were similar between groups.
Conclusions:
- Preemptive bilateral decompression (BAD) is effective in grade I spondylolisthesis TLIF.
- BAD reduces early neural events and enhances very-early recovery.
- BAD does not increase blood loss or compromise fusion rates.
