A meta-analysis of unilateral versus bilateral pedicle screw fixation in minimally invasive lumbar interbody fusion.
METHODS
Meta-analysis.


BACKGROUND
Bilateral pedicle screw fixation (PS) after lumbar interbody fusion is a widely accepted method of managing various spinal diseases. Recently, unilateral PS fixation has been reported as effective as bilateral PS fixation. This meta-analysis aimed to comparatively assess the efficacy and safety of unilateral PS fixation and bilateral PS fixation in the minimally invasive (MIS) lumbar interbody fusion for one-level degenerative lumbar spine disease.


METHODS
MEDLINE/PubMed, EMBASE, BIOSIS Previews, and Cochrane Library were searched through March 30, 2014. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on unilateral versus bilateral PS fixation in MIS lumbar interbody fusion that met the inclusion criteria and the methodological quality standard were retrieved and reviewed. Data on participant characteristics, interventions, follow-up period, and outcomes were extracted from the included studies and analyzed by Review Manager 5.2.


RESULTS
Six studies (5 RCTs and 1 CCT) involving 298 patients were selected. There were no significant differences between unilateral and bilateral PS fixation procedures in fusion rate, complications, visual analogue score (VAS) for leg pain, VAS for back pain, Oswestry disability index (ODI). Both fixation procedures had similar length of hospital stay (MD = 0.38, 95% CI = -0.83 to 1.58; P = 0.54). In contrast, bilateral PS fixation was associated with significantly more intra-operative blood loss (P = 0.002) and significantly longer operation time (P = 0.02) as compared with unilateral PS fixation.


CONCLUSIONS
Unilateral PS fixation appears as effective and safe as bilateral PS fixation in MIS lumbar interbody fusion but requires less operative time and causes less blood loss, thus offering a simple alternative approach for one-level lumbar degenerative disease.
Department of Orthopaedics, Peking University Shougang Hospital, Beijing, China.
Zheng
Z
Liu
Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Qi
Q
Fei
Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Bingqiang
B
Wang
Department of Orthopaedics, Peking University Shougang Hospital, Beijing, China.
Pengfei
P
Lv
Department of Orthopaedics, Peking University Shougang Hospital, Beijing, China.
Cheng
C
Chi
Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Yong
Y
Yang
Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Fan
F
Zhao
Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Jisheng
J
Lin
Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Zhao
Z
Ma
D016063:Blood Loss, Surgical; D016206:Databases, Bibliographic; D006801:Humans; D007902:Length of Stay; D008161:Lumbosacral Region / Q000601:surgery; D019636:Neurodegenerative Diseases / Q000150:complications / Q000601:surgery*; D065289:Pedicle Screws; D016032:Randomized Controlled Trials as Topic; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods*