Unilateral Transpedicular Screw Fixation with Cage Fusion. A Novel Technical Option for Management of Symptomatic Lumbar Foraminal Stenosis

Background: Foraminal stenosis is usually associated with thickening of ligamentum flavum, bulging of intervertebral disc and hypertrophy of facet joint. Wide decompression may cause postoperative instability if weight bearing structures are compromised. Objective: to evaluate unilateral transpedicular screw stabilization with interbody fusion as a technical option for management of symptomatic lumbar foraminal stenosis. Patients and Methods: The study included fourteen patients who underwent unilateral posterior decompression with pedicle screw fixation and single-level interbody fusion from September 2012 to January 2014 with follow-up period up to 12 months later on. The Japanese Orthopedic Association Scale (JOA) was used for evaluation of back pain. The result of surgery was also evaluated with MacNab’s classification. Excellent or good outcome was considered as satisfactory. Results: The average JOA score of the fourteen patients was 6.5 (range, 4-9) before surgery and was 12.5 (range, 10- 15) at the end of this study. Post-operative JOA score improved significantly (p 0.05). There were two cases (14%) of post-operative cerebrospinal fluid (CSF) leak , only one case (7%) of wound infection and were treated conservatively. Satisfactory outcome was achieved in twelve cases (86%). Conclusion: Unilateral pedicle screw fixation with interbody cage fusion after posterior decompression for the unilateral symptomatic foraminal stenosis is an effective option for obtaining satisfactory clinical outcome. Good selection and meticulous surgical procedures give satisfactory outcome in over 85% of cases with follow up period of 12 months.