{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T08:26:30Z","timestamp":1761899190207,"version":"build-2065373602"},"reference-count":44,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Unilateral spinal stabilization has emerged as a less invasive alternative to bilateral fixation in the management of lateralized spinal pathologies. While both rigid and dynamic systems are utilized, comparative data regarding their clinical efficacy, radiological outcomes, and complication profiles\u2014particularly in multilevel applications\u2014remain limited. Materials and Methods: A retrospective, two-center analysis was conducted on 113 patients who underwent unilateral posterior spinal stabilization between 2019 and 2023. Patients were divided into unilateral rigid stabilization (URS, n = 41) and unilateral dynamic stabilization (UDS, n = 72) groups. Pathologies of the patients include disc herniations, foraminal and spinal stenosis, tumoral lesions and spondylolisthesis. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) over a 24-month follow-up. Radiological parameters included fusion status, superior adjacent disc height, and foraminal height index. Complication rates, including adjacent segment degeneration (ASD), pseudoarthrosis, and screw loosening, were analyzed according to type-of-stabilization and construct length (two, three, or four levels). Results: Both URS and UDS groups demonstrated significant VAS improvement at final follow-up, with no significant differences between groups (p &lt; 0.001). Fusion rates were significantly higher in the URS group (85.37% vs. 27.78%, p &lt; 0.001), while pseudoarthrosis (39.02% vs. 16.62%, p = 0.081) were more frequent in URS. No cases of rod fracture or infection were observed. Complication rates, particularly ASD, increased with longer constructs (6.56%, 21.21%, vs. 31.58% p = 0.01), independent of stabilization type. Conclusions: Unilateral stabilization\u2014whether rigid or dynamic\u2014offers effective symptom relief with reduced surgical morbidity. However, dynamic systems may provide biomechanical advantages by preserving motion and minimizing adjacent segment stress. While rigid constructs yield higher fusion rates, they are associated with increased complications. These findings support the use of dynamic stabilization, particularly in multilevel constructs, and highlight the need for patient-specific surgical strategies to optimize outcomes and mitigate long-term complications.<\/jats:p>","DOI":"10.3390\/medicina61111958","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:29:42Z","timestamp":1761895782000},"page":"1958","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Unilateral Posterior Stabilization in Adult Spinal Pathologies: Comparative Clinical, Radiological, and Complication Outcomes of Dynamic Versus Rigid Systems"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8268-6306","authenticated-orcid":false,"given":"Uzay","family":"Erdogan","sequence":"first","affiliation":[{"name":"Bak\u0131rk\u00f6y Prof. Dr. Mazhar Osman Training and Research Hospital, Istanbul 43606, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3672-7343","authenticated-orcid":false,"given":"Ege Anil","family":"Ucar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ko\u00e7 University, Istanbul 34010, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feride","family":"Bulgur Balay","sequence":"additional","affiliation":[{"name":"Bak\u0131rk\u00f6y Prof. Dr. Mazhar Osman Training and Research Hospital, Istanbul 43606, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6434-8143","authenticated-orcid":false,"given":"Gurkan","family":"Berikol","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Health Sciences University, Sincan Training and Research Hospital, Ankara 06949, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrahim Taha","family":"Albas","sequence":"additional","affiliation":[{"name":"Istanbul Physical Therapy and Rehabilitation Training and Research Hospital, Istanbul 43606, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1342-7663","authenticated-orcid":false,"given":"Mehmet Yigit","family":"Akgun","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ko\u00e7 University, Istanbul 34010, Turkey"},{"name":"Spine Center, Koc University Hospital, Istanbul 43606, Turkey"},{"name":"Koc University Research Center for Translational Medicine, Biomechanics and Endurance Laboratory, Istanbul 43606, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tunc","family":"Oktenoglu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ko\u00e7 University, Istanbul 34010, Turkey"},{"name":"Spine Center, Koc University Hospital, Istanbul 43606, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali Fahir","family":"Ozer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ko\u00e7 University, Istanbul 34010, Turkey"},{"name":"Spine Center, Koc University Hospital, Istanbul 43606, Turkey"},{"name":"Koc University Research Center for Translational Medicine, Biomechanics and Endurance Laboratory, Istanbul 43606, Turkey"},{"name":"Bioengineering and Orthopaedic Surgery Colleges of Engineering and Medicine, University of Toledo, Toledo, OH 43606, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ozkan","family":"Ates","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ko\u00e7 University, Istanbul 34010, Turkey"},{"name":"Spine Center, Koc University Hospital, Istanbul 43606, Turkey"},{"name":"Koc University Research Center for Translational Medicine, Biomechanics and Endurance Laboratory, Istanbul 43606, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Thavarajasingam, S.G., Vemulapalli, K.V., Vishnu, K.S., Ponniah, H.S., Vogel, A.S.-M., Vardanyan, R., Neuhoff, J., Kramer, A., Shiban, E., and Ringel, F. (2023). Conservative versus early surgical treatment in the management of pyogenic spondylodiscitis: A systematic review and meta-analysis. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-41381-1"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"E2","DOI":"10.3171\/2016.6.FOCUS16166","article-title":"Decompression surgery for spinal metastases: A systematic review","volume":"41","author":"Bakar","year":"2016","journal-title":"Neurosurg. Focus"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"431","DOI":"10.31616\/asj.2022.0040","article-title":"Deformity Correction with Interbody Fusion Using Lateral versus Posterior Approach in Adult Degenerative Scoliosis: A Systematic Review and Observational Meta-analysis","volume":"17","author":"Mittal","year":"2023","journal-title":"Asian Spine J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"752","DOI":"10.21037\/jss-20-492","article-title":"Trends in lumbar spinal fusion\u2014A literature review","volume":"6","author":"Reisener","year":"2020","journal-title":"J. Spine Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"E840","DOI":"10.1097\/BRS.0000000000003934","article-title":"Thoracolumbar Burst Fractures","volume":"46","author":"Hughes","year":"2021","journal-title":"Spine"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Ahuja, S., Moideen, A., Dudhniwala, A., Karatsis, E., Papadakis, L., and Varitis, E. (2020). Lumbar stability following graded unilateral and bilateral facetectomy: A finite element model study. Clin. Biomech., 75.","DOI":"10.1016\/j.clinbiomech.2020.105011"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1007\/BF01808874","article-title":"Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis part II: Clinical experiences","volume":"139","author":"Spetzger","year":"1997","journal-title":"Acta Neurochir."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1007\/BF01808872","article-title":"Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis","volume":"139","author":"Spetzger","year":"1997","journal-title":"Acta Neurochir."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Algarni, N., Al-Amoodi, M., Marwan, Y., Bokhari, R., Addar, A., Alshammari, A., Alaseem, A., Albishi, W., Alshaygy, I., and Alabdullatif, F. (2023). Unilateral laminotomy with bilateral spinal canal decompression: Systematic review of outcomes and complications. BMC Musculoskelet. Disord., 24.","DOI":"10.1186\/s12891-023-07033-1"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Yang, K., Wu, D., Kong, J., Peng, X., Wu, H., Wang, S., Wang, H., Zhu, X., Wu, Z., and Yang, S. (2025). Unilateral versus bilateral pedicle screw fixation for treating two-level lumbar degenerative diseases. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-13015-1"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"13337","DOI":"10.12998\/wjcc.v10.i36.13337","article-title":"Successful outcomes of unilateral vs. bilateral pedicle screw fixation for lumbar interbody fusion: A meta-analysis with evidence grading","volume":"10","author":"Sun","year":"2022","journal-title":"World J. Clin. Cases"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.ijsu.2017.03.055","article-title":"Comparison of unilateral versus bilateral pedicle screw fixation at the level of fracture using posterior short-segment pedicle instrumentation in the treatment of severe thoracolumbar burst fractures","volume":"41","author":"Sun","year":"2017","journal-title":"Int. J. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Hu, X.-Q., Wu, X.-L., Xu, C., Zheng, X.-H., Jin, Y.-L., Wu, L.-J., Wang, X.-Y., Xu, H.-Z., and Tian, N.-F. (2014). A Systematic Review and Meta-Analysis of Unilateral versus Bilateral Pedicle Screw Fixation in Transforaminal Lumbar Interbody Fusion. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0087501"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.3349\/ymj.2014.55.5.1386","article-title":"Biomechanical Analysis of Fusion Segment Rigidity Upon Stress at Both the Fusion and Adjacent Segments: A Comparison between Unilateral and Bilateral Pedicle Screw Fixation","volume":"55","author":"Kim","year":"2014","journal-title":"Yonsei Med. J."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Gunerbuyuk, C., Akgun, M.Y., Durmus, N., Ucar, E.A., Orak, H.I., Oktenoglu, T., Ates, O., Akgul, T., and Ozer, A.F. (2025). Dynamic vs. Rigid: Transforming the Treatment Landscape for Multisegmental Lumbar Degeneration. J. Clin. Med., 14.","DOI":"10.3390\/jcm14155472"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"152","DOI":"10.14444\/8588","article-title":"Can Dynamic Spinal Stabilization Be an Alternative to Fusion Surgery in Adult Spinal Deformity Cases?","volume":"18","author":"Ozer","year":"2024","journal-title":"Int. J. Spine Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"S240","DOI":"10.1002\/acr.20543","article-title":"Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP)","volume":"63","author":"Hawker","year":"2011","journal-title":"Arthr. Care Res."},{"key":"ref_18","first-page":"35","article-title":"Foraminal height measurement techniques","volume":"1","author":"Phan","year":"2015","journal-title":"J. Spine Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2152","DOI":"10.1007\/s00586-007-0515-7","article-title":"Disc height reduction in adjacent segments and clinical outcome 10 years after lumbar 360\u00b0 fusion","volume":"16","author":"Schulte","year":"2007","journal-title":"Eur. Spine J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e23.00028","DOI":"10.2106\/JBJS.RVW.23.00028","article-title":"Adjacent Segment Disease After Spinal Fusion","volume":"11","author":"McDonald","year":"2023","journal-title":"JBJS Rev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3465","DOI":"10.1177\/21925682251336715","article-title":"Radiological Assessment of Lumbar Fusion Status: Which Imaging Modality is Best Assessing Non-union in Lumbar Spine Pseudarthrosis?","volume":"15","author":"Ekert","year":"2025","journal-title":"Glob. Spine J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1007\/s00256-019-03181-5","article-title":"The diagnostic accuracy of imaging modalities to detect pseudarthrosis after spinal fusion\u2014A systematic review and meta-analysis of the literature","volume":"48","author":"Peters","year":"2019","journal-title":"Skelet. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Mu, X., Deng, H., Wei, X., Wei, J., and Caggiari, G. (2023). Do Modic changes contribute to lumbar instability or other way around? A retrospective study based on their types, extents, and affected lumbar segments. BMC Musculoskelet. Disord., 24.","DOI":"10.1186\/s12891-023-07011-7"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e393","DOI":"10.1016\/j.wneu.2019.05.163","article-title":"Vacuum Facet Phenomenon in Computed Tomography Imaging: A Sign of Instability in Degenerative Spondylolisthesis?","volume":"129","author":"Sun","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1007\/s00586-011-1993-1","article-title":"Lumbar facet joint effusion in MRI: A sign of instability in degenerative spondylolisthesis?","volume":"21","author":"Lattig","year":"2012","journal-title":"Eur. Spine J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1053\/crad.2001.0899","article-title":"Segmental Lumbar Spine Instability at Flexion\u2013Extension Radiography can be Predicted by Conventional Radiography","volume":"57","author":"Manninen","year":"2002","journal-title":"Clin. Radiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1177\/21925682221099854","article-title":"Radiological Definitions of Sagittal Plane Segmental Instability in the Degenerative Lumbar Spine\u2014A Systematic Review","volume":"13","author":"Elmose","year":"2023","journal-title":"Glob. Spine J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1007\/s00586-013-3100-2","article-title":"Comparison of unilateral versus bilateral pedicle screw fixation in lumbar interbody fusion: A meta-analysis","volume":"23","author":"Ding","year":"2014","journal-title":"Eur. Spine J."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Liu, Z., Fei, Q., Wang, B., Lv, P., Chi, C., Yang, Y., Zhao, F., Lin, J., and Ma, Z. (2014). A Meta-Analysis of Unilateral Versus Bilateral Pedicle Screw Fixation in Minimally Invasive Lumbar Interbody Fusion. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0111979"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.3171\/2015.10.FOCUS15426","article-title":"Dynamic stabilization using the Dynesys system versus posterior lumbar interbody fusion for the treatment of degenerative lumbar spinal disease: A clinical and radiological outcomes-based meta-analysis","volume":"40","author":"Lee","year":"2016","journal-title":"Neurosurg. Focus"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e19784","DOI":"10.1097\/MD.0000000000019784","article-title":"Dynesys system vs posterior decompression and fusion for the treatment of lumbar degenerative diseases","volume":"99","author":"Wang","year":"2020","journal-title":"Medicine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1007\/s00264-018-4241-z","article-title":"Adjacent segment degeneration after fusion spinal surgery\u2014A systematic review","volume":"43","author":"Hashimoto","year":"2019","journal-title":"Int. Orthop."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1177\/2192568218766488","article-title":"Adjacent Segment Disease After Posterior Lumbar Interbody Fusion: A Case Series of 1000 Patients","volume":"8","author":"Okuda","year":"2018","journal-title":"Glob. Spine J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.spinee.2010.09.026","article-title":"Incidence and prevalence of surgery at segments adjacent to a previous posterior lumbar arthrodesis","volume":"11","author":"Sears","year":"2011","journal-title":"Spine J."},{"key":"ref_35","first-page":"334","article-title":"Unilateral dynamic stabilization in recurrent lumbar disc herniation","volume":"33","author":"Sezer","year":"2022","journal-title":"Turk. Neurosurg."},{"key":"ref_36","first-page":"718","article-title":"Unilateral dynamic stabilization for unilateral lumbar spinal pathologies; a new surgical concept","volume":"22","author":"Bozkus","year":"2012","journal-title":"Turk. Neurosurg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.spinee.2012.01.010","article-title":"Comparison of unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in degenerative lumbar diseases","volume":"12","author":"Xue","year":"2012","journal-title":"Spine J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"338","DOI":"10.21037\/jss.2017.06.16","article-title":"Early clinical and radiological results of unilateral posterior pedicle instrumentation through a Wiltse approach with lateral lumbar interbody fusion","volume":"3","author":"Du","year":"2017","journal-title":"J. Spine Surg."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Chen, R., Dou, Y., Peng, C., Liang, Y., Chen, J., Li, S., Wu, Z., and Li, Y. (2025). Biomechanical effects of transforaminal endoscopic lumbar discectomy combined with spinal dynamic stabilization system use on adjacent segments: A finite element analysis. BMC Musculoskelet. Disord., 26.","DOI":"10.1186\/s12891-025-08825-3"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Zhou, L.-P., Zhang, R.-J., Wang, J.-Q., Zhang, H.-Q., Shang, J., Gao, Y., Jia, C.-Y., Ding, J.-Y., Zhang, L., and Shen, C.-L. (2023). Medium and long-term radiographic and clinical outcomes of Dynesys dynamic stabilization versus instrumented fusion for degenerative lumbar spine diseases. BMC Surg., 23.","DOI":"10.1186\/s12893-023-01943-6"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Subramanian, T., Sarpong, S.O., Hirase, T., Oquendo, Y., Dekhne, M., Asada, T., Harhash, T., Zhao, E.R., Ehrlich, A., and Durbas, A. (2025). Is it Necessary to Fuse? A Propensity Score-Matched Analysis of One- Versus Two-Level Fusions With Multilevel Decompression. Glob. Spine J.","DOI":"10.1177\/21925682251370264"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.jos.2016.12.003","article-title":"Prognosis and adjacent segment disease after lumbar spinal fusion surgery for destructive spondyloarthropathy in long-term hemodialysis patients","volume":"22","author":"Maruo","year":"2017","journal-title":"J. Orthop. Sci."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Akgun, M.Y., Aydin, A.L., Ucar, E.A., Savasci, M., Orak, H.I., Gunerbuyuk, C., Oktenoglu, T., Sasani, M., Ates, O., and Ozer, A.F. (2025). Dynamic stabilization for unilateral spinal pathologies: Clinical efficacy and safety outcomes. BMC Musculoskelet. Disord., 26.","DOI":"10.1186\/s12891-024-08097-3"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.promfg.2019.02.188","article-title":"Recent Trends in Bioprinting","volume":"32","author":"Moldovan","year":"2019","journal-title":"Procedia Manuf."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/11\/1958\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:46:15Z","timestamp":1761896775000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/11\/1958"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":44,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["medicina61111958"],"URL":"https:\/\/doi.org\/10.3390\/medicina61111958","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,31]]}}}