Lower Back Pain and Sciatica Treatment: Houston Kraus Back and Neck Institute Reviews Controversial Unilateral vs Bilateral Lumbar Fusion

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Controversy exists as to the best operation for lower back pain and sciatica. Lower back pain and sciatica may be improved with lumbar fusion surgery, but whether to have a unilateral or bilateral lumbar fusion performed remains a question: addressed by the Kraus Back and Neck Institute.



Unilateral vs Bilateral Lumbar Fusion Remains Controversial.

Lower back surgery is one of the mainstays for lower back pain treatment. There is controversy as to whether unilateral or bilateral lumbar fusion may be the best treatment. According to Gary Kraus M.D., “the goal of surgery should be to do the least possible procedure in the operating room in order to achieve a desired result, but on the other hand, enough of an operation should be performed so that there is a strong chance of achieving the desired result, and avoiding the need for additional surgery in the future.” Traditionally, lumbar fusion has consisted of placing pedicle screws and rods on both sides of the lumbar spine, in order to immobilize the spine while a fusion of bone is occurring during the year following surgery. Masaki Oishi M.D., Ph.D. added “some surgeons have performed the fusion on only one side of the spine, leaving the other side of the spine untouched. This has caused controversy as to which was the best approach, and studies have been done to compare the outcomes.”

In a study by Dong et al (Journal of Neurosurgery Spine, 20:53-59,2014), thirty nine patients were divided into two groups: 1) 20 patients underwent a minimally invasive Wiltse approach lumbar decompression and fusion through a tubular retractor, 2) 19 patients underwent a bilateral midline incision lumbar decompression and fusion. They concluded that for single segment lumbar degenerative instability, unilateral pedicle screw fixation was as safe and effective as bilateral pedicle screw fixation. One limitation of this study was that the unilateral fixation was performed through a minimally invasive approach, whereas the bilateral fixation was done through a midline conventional approach. Dahdaleh et al (Neurosurgery Focus,35(2):E13,2013) evaluated forty one patients who were randomized to either unilateral or bilateral instrumentation following a minimally invasive interbody fusion. A follow up of roughly one year showed no significant differences in outcome or fusion between the two groups. Choi et al (Neurosurgery Focus,35(2):E11,2013) performed a prospective randomized study of 53 patients, who were divided into two groups of unilateral or bilateral percutaneous pedicle screw fixation after a minimally invasive interbody fusion. They concluded that while the perioperative results with patients undergoing unilateral screw fixation were better, the results for fusion rates and postoperative scoliosis changes were better with bilateral screw fixation.

Dr. Gary Kraus notes, “Traditionally, most lumbar spine fusions involve bilateral placement of instrumentation. This certainly provides immediate stability, which helps to promote bone fusion. The studies discussed suggest that in certain cases, a unilateral fusion may provide similar results.” Dr. Masaki Oishi added, “The subject of unilateral vs bilateral lumbar fusion needs more evaluation, so that we can always provide the best possible treatment to our patients.”

Gary Kraus MD is Director of Neuroscience and Gamma Knife at West Houston Medical Center, and past Chairman of Neurosurgery at Memorial Hermann Memorial City Hospital, Houston, TX. He is Assistant Clinical Professor, Department of Neurosurgery at the University of Texas Medical School at Houston. Dr. Kraus is Board Certified by the American Board of Neurological Surgery, and is a Fellow of the American Association of Neurological Surgeons. He has been listed in “Best Doctors in America,” and featured among “Best Neurosurgeons in Texas” and “Neurosurgery Leaders in the United States” in Newsweek; listed in “Who’s Who in America.”

Publications of Dr. Kraus include the textbook Microsurgical Anatomy of the Brain: A Stereo Atlas (published by Williams and Wilkins) in addition to numerous chapters and peer reviewed papers in the neurosurgical literature.

Masaki Oishi M.D., Ph.D. completed a Spine Surgery Fellowship at the University of PittsburghMedical Center Department of Neurosurgery in 2003. Born in New York City, he attended Cornell University Medical College, completing his M.D. degree in 1996. Dr. Oishi received a Ph.D. in Molecular and Cellular Neuroscience from the Rockefeller University in New York. He received his Neurosurgery residency training at the Montefiore Medical Center / Albert Einstein College of Medicine in New York City. Dr. Oishi is Board Certified by the American Board of Neurological Surgery. He has been the recipient of the National Institutes of Health National Research Service Award.

Both Doctors Kraus and Oishi at the Kraus Back and Neck Institute specialize in both minimally invasive as well as traditional surgical approaches to the spine. When non surgical treatments of back and neck pain are an option, they are frequently utilized. They also have expertise in brain surgery, including the treatment of brain tumors, hemorrhages, and hydrocephalus. The Kraus Back and Neck Institute treats patients in Houston, Katy, Humble, Kingwood, The Woodlands, Sugarland, Memorial City, Beaumont and Galveston.

For patients traveling locally or from other cities, appointments can be made by calling 281-870-9292.

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