Comparing unilateral and bilateral facetectomy in transforaminal lumbar interbody fusion: Impact on patient satisfaction and surgical outcomes.

BACKGROUND

This study investigates whether patient satisfaction, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, clinical and radiographic outcomes differ between unilateral and bilateral facetectomy when performing transforaminal lumbar interbody fusions (TLIFs).

METHODS

We retrospectively reviewed 373 patients who underwent primary 1- or 2-level TLIF (2016-2023) at a tertiary care center; patients underwent unilateral (n = 160) or bilateral (n = 213) facetectomy. Demographic, surgical, and radiographic data were collected, along with patient-reported satisfaction using the HCAHPS survey.

RESULTS

We found no significant differences in complication rates, reoperation rates, or radiographic outcomes between unilateral and bilateral facetectomy groups. HCAHPS scores showed no statistically significant differences in patient satisfaction across measured domains. Unilateral facetectomy was associated with a shorter hospital stay and more frequent use of minimally invasive techniques. Multivariable regression identified increased BMI associated with increased odds of postoperative infection and additional surgery. Increased operative time was associated with postoperative infection and intraoperative durotomy. Finally, increased length of stay was associated with increased odds of intraoperative durotomy and instrumentation failure.

CONCLUSION

For TLIF, unilateral versus bilateral facetectomy provided comparable clinical and radiographic outcomes, with no significant differences in patient satisfaction.