Comparison of the clinical efficacy of full-endoscopic large-channel interbody decompression and fusion with unilateral versus bilateral pedicle-screw fixation in the treatment of lumbar degenerative disease

Background: Comparison of the clinical efficacy of full-endoscopic large-channel interbody decompression and fusion combined with unilateral versus bilateral pedicle-screw fixation in the treatment of single-level lumbar degenerative disease. Methods: We conducted a retrospective analysis of the clinical data of 56 patients with single-level lumbar degenerative disease who underwent full-endoscopic large-channel interbody decompression, fusion, and internal fixation surgery at our hospital. Among them, 26 patients underwent unilateral pedicle screw fixation (UPSF), and 30 patients underwent bilateral pedicle screw fixation (BPSF).The comparison included the following parameters: surgical time, intraoperative fluoroscopy frequency, hospitalization costs, length of hospital stay, changes in hemoglobin levels before and after surgery, and complication rates. Preoperative and postoperative pain were assessed using the Visual Analog Scale (VAS) at 3 days, 3 months, and 1 year. Functional disability was evaluated using the Oswestry Disability Index (ODI) at preoperative, 3-month, and 1-year follow-ups. One year post-surgery, interbody fusion was evaluated by CT, and clinical outcomes were assessed using the modified MacNab criteria. Results: The surgical time, intraoperative fluoroscopy frequency, hospitalization costs, and length of hospital stay were significantly higher in the BPSF group compared to the UPSF group (P < 0.05). There was no statistical difference in the changes in hemoglobin levels between the two groups postoperatively (P > 0.05). The VAS scores at 3 days, 3 months, and 1 year, as well as the ODI scores at 3 months and 1 year, were significantly lower than preoperative values in both groups (P < 0.05). However, there were no significant differences in the VAS and ODI scores at the same time points between the two groups (P > 0.05). The complication rates, fusion rates at 1 year, and the excellent rate according to the modified MacNab criteria were not significantly different between the two groups (P > 0.05). Conclusions: The treatment of single-segment lumbar degenerative disease using a large-channel full-endoscopic intervertebral decompression and fusion combined with UPSF is safe and effective. Compared with BPSF group, UPSF group has advantages in terms of fewer fluoroscopy times, shorter surgical duration, lower hospitalization costs, and shorter hospital stays.