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Bilateral versus unilateral decompression in single-level TLIF for degenerative spondylolisthesis: a retrospective
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 City, Jiangsu Province, China.
Purpose:
To assess if preemptive bilateral decompression (BAD) lowers early neural events and enhances very-early recovery versus unilateral approach decompression (UAD) in single-level TLIF 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 (VAS/ODI/JOA 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 min; p<0.001). BAD improved very-early recovery: VAS POD7 4.2±0.6 vs 5.0±0.7 (p<0.001). Neural events were lower in BAD: EPRP 1.9% vs 9.8% (p=0.017), contralateral aggravation 0% vs 4.9% (p=0.027). Two-year JOA recovery was similar (73% vs 73%).
Conclusion:
In grade I spondylolisthesis TLIF, BAD reduces early neural events and boosts very-early recovery without added blood loss or fusion compromise..
