Related Experiment Video
Updated: Jan 13, 2026
Novel Mini-open Transforaminal Lumbar Interbody Fusion
Published on: June 6, 2025
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.
Objective:
To assess if pre-emptive bilateral approach decompression (BAD) lowers early neural events and enhances very-early recovery versus unilateral approach decompression (UAD) in single-level transforaminal lumbar interbody fusion for Meyerding grade I degenerative spondylolisthesis.
Methods:
Single-center retrospective study (2015-2022) with ≥24-month follow-up. Allocation by practice evolution: UAD (2015-2018) and BAD (2019-2022), limited to uniform mild-to-moderate contralateral risks.
Primary Endpoints:
very-early recovery (visual analog scale/Oswestry Disability Index/Japanese Orthopaedic Association at postoperative day [POD] 1/POD7) and neural complications.
Results:
Analyzed 208 patients (UAD n = 102; BAD n = 106). BAD had longer operative time (114 ± 10 vs. 75 ± 9 minutes; P < 0.001). BAD improved very-early recovery: visual analog scale POD7 4.2 ± 0.6 versus 5.0 ± 0.7 (P < 0.001). Neural events were lower in BAD: early postoperative radicular pain 1.9% versus 9.8% (P = 0.017) and contralateral aggravation 0% versus 4.9% (P = 0.027). Two-year Japanese Orthopaedic Association recovery was similar (73% vs. 73%).
Conclusions:
In grade I spondylolisthesis transforaminal lumbar interbody fusion, BAD reduces early neural events and boosts very-early recovery without added blood loss or fusion compromise.
