Abstract：
OBJECTIVE: To determine of the impact of ALIF with minimally invasive unilateral pedicle screw fixation (UPSF) versus bilateral pedicle screw fixation (BPSF) on perioperative outcomes, radiographic outcomes, and the rates of fusion, subsidence, and adjacent segment stenosis.
METHODS: All adult patients who underwent one-level ALIF with UPSF or BPSF at an academic institution between 2015 and 2022 were retrospectively identified. Postoperative outcomes including length of hospital stay (LOS), wound complications, readmissions, and revisions were determined. The rates of fusion, screw loosening, adjacent segment stenosis, and subsidence were assessed on one-year postoperative CT. Lumbar alignment including lumbar lordosis, L4-S1 lordosis, regional lordosis, pelvic tilt, pelvic incidence, and sacral slope were assessed on standing x-rays at preoperative, immediate postoperative, and final postoperative follow-up. Univariate and multivariate analysis compared outcomes across posterior fixation groups.
RESULTS: A total of 60 patients were included (27 UPSF, 33 BPSF). Patients with UPSF were significantly younger (p = 0.011). Operative time was significantly greater in the BPSF group in univariate (p < 0.001) and multivariate analysis (ß=104.1, p < 0.001). Intraoperative blood loss, LOS, lordosis, pelvic parameters, fusion rate, subsidence, screw loosening, adjacent segment stenosis, and revision rate did not differ significantly between fixation groups. Though sacral slope (p = 0.037) was significantly greater in the BPSF group, fixation type was not a significant predictor on regression.
CONCLUSIONS: ALIF with UPSF relative to BPSF predicted decreased operative time but was not a significant predictor of postoperative outcomes. ALIF with UPSF can be considered to increase operative efficiency without compromising construct stability.
METHODS: All adult patients who underwent one-level ALIF with UPSF or BPSF at an academic institution between 2015 and 2022 were retrospectively identified. Postoperative outcomes including length of hospital stay (LOS), wound complications, readmissions, and revisions were determined. The rates of fusion, screw loosening, adjacent segment stenosis, and subsidence were assessed on one-year postoperative CT. Lumbar alignment including lumbar lordosis, L4-S1 lordosis, regional lordosis, pelvic tilt, pelvic incidence, and sacral slope were assessed on standing x-rays at preoperative, immediate postoperative, and final postoperative follow-up. Univariate and multivariate analysis compared outcomes across posterior fixation groups.
RESULTS: A total of 60 patients were included (27 UPSF, 33 BPSF). Patients with UPSF were significantly younger (p = 0.011). Operative time was significantly greater in the BPSF group in univariate (p < 0.001) and multivariate analysis (ß=104.1, p < 0.001). Intraoperative blood loss, LOS, lordosis, pelvic parameters, fusion rate, subsidence, screw loosening, adjacent segment stenosis, and revision rate did not differ significantly between fixation groups. Though sacral slope (p = 0.037) was significantly greater in the BPSF group, fixation type was not a significant predictor on regression.
CONCLUSIONS: ALIF with UPSF relative to BPSF predicted decreased operative time but was not a significant predictor of postoperative outcomes. ALIF with UPSF can be considered to increase operative efficiency without compromising construct stability.
摘要：
目的：确定ALIF联合微创单侧椎弓根螺钉内固定（UPSF）与双侧椎弓根螺钉内固定（BPSF）对围手术期结局的影响，射线照相结果，和融合率，沉降,和相邻节段狭窄。
方法：对所有在2015年至2022年期间在学术机构接受UPSF或BPSF一级ALIF的成年患者进行回顾性鉴定。术后结果包括住院时间（LOS），伤口并发症,再入院,并确定了修订。融合率，螺钉松动,相邻节段狭窄,和沉降在术后1年的CT上进行评估。腰椎对准包括腰椎前凸,L4-S1脊柱前凸,区域脊柱前凸,骨盆倾斜,骨盆发病率,术前在站立X射线上评估骶骨斜率，术后即刻,和最后的术后随访。单变量和多变量分析比较了后固定组的结果。
结果：共纳入60例患者(27例UPSF，33BPSF)。UPSF患者明显年轻（p=0.011）。单因素分析(p<0.001)和多因素分析(β=104.1,p<0.001)中BPSF组的手术时间显著延长。术中失血,LOS,脊柱前凸,骨盆参数,融合率,沉降,螺钉松动,相邻节段狭窄,固定组之间的翻修率没有显着差异。尽管BPSF组的骶骨斜率（p=0.037）明显更大，固定类型不是回归的显著预测因子.
结论：ALIF与UPSF相对于BPSF预测手术时间缩短，但不是术后结局的显著预测指标。具有UPSF的ALIF可以被认为在不损害构造稳定性的情况下提高手术效率。
方法：对所有在2015年至2022年期间在学术机构接受UPSF或BPSF一级ALIF的成年患者进行回顾性鉴定。术后结果包括住院时间（LOS），伤口并发症,再入院,并确定了修订。融合率，螺钉松动,相邻节段狭窄,和沉降在术后1年的CT上进行评估。腰椎对准包括腰椎前凸,L4-S1脊柱前凸,区域脊柱前凸,骨盆倾斜,骨盆发病率,术前在站立X射线上评估骶骨斜率，术后即刻,和最后的术后随访。单变量和多变量分析比较了后固定组的结果。
结果：共纳入60例患者(27例UPSF，33BPSF)。UPSF患者明显年轻（p=0.011）。单因素分析(p<0.001)和多因素分析(β=104.1,p<0.001)中BPSF组的手术时间显著延长。术中失血,LOS,脊柱前凸,骨盆参数,融合率,沉降,螺钉松动,相邻节段狭窄,固定组之间的翻修率没有显着差异。尽管BPSF组的骶骨斜率（p=0.037）明显更大，固定类型不是回归的显著预测因子.
结论：ALIF与UPSF相对于BPSF预测手术时间缩短，但不是术后结局的显著预测指标。具有UPSF的ALIF可以被认为在不损害构造稳定性的情况下提高手术效率。
