Effectiveness and safety of unilateral pedicle screw fixation in transforaminal lumbar interbody fusion (TLIF): a systematic review and meta-analysis.
OBJECTIVE
To evaluate the effectiveness and safety of unilateral pedicle screw fixation in transforaminal lumbar interbody fusion (TLIF) by comparing with bilateral pedicle screw fixation.


METHODS
PubMed, EMBASE, and the Cochrane Central Register of Controlled Trial database were used to search and identify clinical prospective trials that evaluated the efficacy and safety of unilateral fixation as compared with bilateral fixation in TLIF surgery. The methodological qualities of studies were assessed using the PEDro (Physiotherapy Evidence Database) score and Newcastle-Ottawa Scale.


RESULTS
Fourteen prospective studies comprising 954 participants were analyzed. Data synthesis show lower fusion rate (P = 0.03) and more cage migration (P = 0.04) in unilateral group compared to bilateral group. There was no significant difference in visual analog scale (VAS), Oswestry Disability Index (ODI), the Short Form 36 Health Survey (SF-36) physical component score (PCS), and length of hospital stay between unilateral and bilateral groups. The unilateral group had shorter operative time (P < 0.00001) and less blood loss (P = 0.0007).


CONCLUSIONS
Based on this systematic review and meta-analysis, the unilateral fixation in TLIF may achieve a similar clinical outcome and reduce blood loss and operative time when compared with that in bilateral fixation. However, the unilateral fixation may produce lower fusion rate and more cage migration than bilateral fixation in TLIF.
Department Orthoped, Lianyungang No.1 People's Hospital, Xuzhou Academy of Medical Sciences, 182 Tongguang Rd, Lianyungang, Jiangsu, 222002, People's Republic of China. rcpspine@163.com.
Chunpeng
C
Ren
Department Orthoped, Lianyungang No.1 People's Hospital, Xuzhou Academy of Medical Sciences, 182 Tongguang Rd, Lianyungang, Jiangsu, 222002, People's Republic of China.
Rujie
R
Qin
Department Orthoped, Lianyungang No.1 People's Hospital, Xuzhou Academy of Medical Sciences, 182 Tongguang Rd, Lianyungang, Jiangsu, 222002, People's Republic of China.
Penghao
P
Sun
Department Orthoped, Lianyungang No.1 People's Hospital, Xuzhou Academy of Medical Sciences, 182 Tongguang Rd, Lianyungang, Jiangsu, 222002, People's Republic of China.
Peng
P
Wang
D016063:Blood Loss, Surgical; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery*; D061646:Operative Time; D010147:Pain Measurement; D065289:Pedicle Screws; D011446:Prospective Studies; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome; D064232:Visual Analog Scale
Bilateral; Meta-analysis; Pedicle screw; Transforaminal lumbar interbody fusion; Unilateral