Unilateral versus bilateral pedicle screw fixation of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF): a meta-analysis of randomized controlled trials.
BACKGROUND
A few studies focused on unilateral or bilateral pedicle screw (PS) fixation of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) to treat lumbar degenerative diseases have been published. There is still debate over whether one method is superior to another. A systematic review and meta-analysis of randomized controlled trials (RCT) was performed to compare the efficacy of the two methods.


METHODS
We searched the established electronic literature databases of MEDLINE, EMBASE, Web of Science and the Cochrane Central Register of Controlled Trials databases for RCTs comparing the unilateral with bilateral pedicle screw fixation of MIS-TLIF. Pooled mean differences (MD) and odds ratios (OR) and with 95% CIs were calculated for the outcomes.


RESULTS
Three RCTs were identified and analyzed. The results showed that there is no significant difference between the two methods in terms of postoperative VAS-BP score (WMD = -0.09; 95% CI: -0.69 to 0.51; P =0.78), ODI (WMD, -0.09; 95% CI -5.85 to 5.67; P =0.98), fusion rate (OR = 2.99; 95% CI 0.55 to 16.38; P = 0.21) or complication rate (OR = 1.61, 95% CI: 0.49 to 5.37; P =0.43). Unilateral pedicle screw fixation was associated with less blood loss (WMD = -87.83; 95% CI: -160.70 to -14.96; P =0.02).


CONCLUSIONS
The existing evidence indicate that no superiority exists between the two fixation methods of MIS-TLIF in terms of functional outcome, fusion rate and complication rate, in spite of that unilateral pedicle screw fixation can achieve less blood loss than bilateral fixation.
Liang
L
Wang
Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan Hutong, Beijing 100730, China. wlliangwang@sina.com.
Yipeng
Y
Wang
Zhengyao
Z
Li
Bin
B
Yu
Ye
Y
Li
D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D065289:Pedicle Screws; D016032:Randomized Controlled Trials as Topic; D013123:Spinal Fusion / Q000379:methods*