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Unilateral versus bilateral pedicle screw fixation in short-segment lumbar spinal fusion: a meta-analysis of randomised controlled trials

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Abstract

Objective

We performed this meta-analysis of randomised controlled trials to compare the efficacy and safety of unilateral with bilateral fixation in short-segment lumbar spinal fusion.

Methods

Predefined terms were used to search electronic databases to identify relevant research. Randomised controlled trials (RCTs) published in English and Chinese during 1990–2015 investigating efficacy and safety of unilateral and bilateral fixation in short-segment lumbar spinal fusion were included. Data of fusion rate, complications, visual analogue scale (VAS), Oswestry Disability Index (ODI), estimated blood loss (EBL) and length of hospital stay were extracted and analysed. Two reviewers independently searched information sources, selected eligible research, analysed data and evaluated risk of bias.

Results

Eleven RCTs comprising 756 participants were analysed. There was no significant difference in fusion rate, device-related complication, ODI, VAS and length of hospital stay between bilateral and unilateral groups. The unilateral group had the obvious advantage of reduced blood loss [mean difference (MD) −143.57, 95 % confidence interval (Cl) -206.61 to -80.54, P < 0.0001) and operation time (MD -52.72, 95 % Cl -73.58 to -31.87, P < 0.00001).

Conclusion

Unilateral pedicle screw fixation is equally as effective as bilateral pedicle screw fixation in short-segment lumbar spinal fusion and may reduce operation time and blood loss.

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Reference

  1. Goel VK, Lim TH, Gwon J, Chen JY, Winterbottom JM, Park JB, Weinstein JN, Ahn JY (1991) Effects of rigidity of an internal fixation device. A comprehensive biomechanical investigation. Spine 16:S155–61

    Article  CAS  PubMed  Google Scholar 

  2. Xue H, Tu Y, Cai M (2012) Comparison of unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in degenerative lumbar diseases. Spine J 12:209–15

    Article  PubMed  Google Scholar 

  3. Zhang K, Sun W, Zhao CQ, Li H, Ding W, Xie YZ, Sun XJ, Zhao J (2014) Unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in two-level degenerative lumbar disorders: a prospective randomised study. Int Orthop 38(1):111–6

    Article  PubMed  Google Scholar 

  4. Choi UY, Park JY, Kim KH, Kuh SU, Chin DK, Kim KS, Cho YE (2013) Unilateral versus bilateral percutaneous pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion. Neurosurg Focus 35:E11

    Article  PubMed  Google Scholar 

  5. Suk KS, Lee HM, Kim NH, Ha JW (2000) Unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion. Spine 25:1843–7

    Article  CAS  PubMed  Google Scholar 

  6. Duncan JW, Bailey RA (2013) An analysis of fusion cage migration in unilateral and bilateral fixation with transforaminal lumbar interbody fusion. Eur Spine J 22:439–45

    Article  PubMed Central  PubMed  Google Scholar 

  7. Fernández-Fairen M, Sala P, Ramírez H, Gil J (2007) A prospective randomized study of unilateral versus bilateral instrumented posterolateral lumbar fusion in degenerative spondylolisthesis. Spine 32:395–401

    Article  PubMed  Google Scholar 

  8. Aoki Y, Yamagata M, Ikeda Y, Nakajima F, Ohtori S, Nakagawa K, Nakajima A, Toyone T, Orita S, Takahashi K (2012) A prospective randomized controlled study comparing transforaminal lumbar interbody fusion techniques for degenerative spondylolisthesis: unilateral pedicle screw and 1 cage versus bilateral pedicle screws and 2 cages. J Neurosurg Spine 17:153–9

    Article  PubMed  Google Scholar 

  9. Dahdaleh NS, Nixon AT, Lawton CD, Wong AP, Smith ZA, Fessler RG (2013) Outcome following unilateral versus bilateral instrumentation in patients undergoing minimally invasive transforaminal lumbar interbody fusion: a single-center randomized prospective study. Neurosurg Focus 35:E13

    Article  PubMed  Google Scholar 

  10. van Tulder M, Furlan A, Bombardier C, Bouter L, Editorial Board of the Cochrane Collaboration Back Review Group (2003) Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group. Spine 28:1290–9

    PubMed  Google Scholar 

  11. Higgins JPT, Green S (2011) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration. Available from www.cochrane-handbook.org

  12. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLoS Med 6:e1000097

    Article  PubMed Central  PubMed  Google Scholar 

  13. Cochran WG (1954) The combination of estimates from different experiments. Biometrics 10:101–29

    Article  Google Scholar 

  14. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in metaanalyses. BMJ 327:557–60

    Article  PubMed Central  PubMed  Google Scholar 

  15. Xie Y, Ma H, Li H, Ding W, Zhao C, Zhang P, Zhao J (2012) Comparative study of unilateral and bilateral pedicle screw fixation in posterior lumbar interbody fusion. Orthopedics 35:e1517–23

    Article  PubMed  Google Scholar 

  16. Feng ZZ, Cao YW, Jiang C, Jiang XX (2011) Short-term outcome of bilateral decompression via a unilateral paramedian approach for transforaminal lumbar interbody fusion with unilateral pedicle screw fixation. Orthopedics 34:364

    PubMed  Google Scholar 

  17. Lin B, Lin QY, He MC, Liu H, Guo ZM, Lin KS (2012) Clinical study on unilateral pedicle screw fixation and interbody fusion for the treatment of lumbar degenerative diseases under Quadrant system. Zhongguo Gu Shang 25:468–73

    PubMed  Google Scholar 

  18. Dong J, Rong L, Feng F, Liu B, Xu Y, Wang Q, Chen R, Xie P (2014) Unilateral pedicle screw fixation through a tubular retractor via the Wiltse approach compared with conventional bilateral pedicle screw fixation for single-segment degenerative lumbar instability: a prospective randomized study. J Neurosurg Spine 20:53–59

    Article  PubMed  Google Scholar 

  19. Fischgrund JS (2004) The argument for instrumented decompressive posterolateral fusion for patients with degenerative spondylolisthesis and spinal stenosis. Spine 29:173–4

    Article  PubMed  Google Scholar 

  20. Kornblum MB, Fischgrund JS, Herkowitz HN, Abraham DA, Berkower DL, Ditkoff JS (2004) Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion and pseudarthrosis. Spine 29:726–33

    Article  PubMed  Google Scholar 

  21. Nagata H, Schendel MJ, Transfeldt EE, Lewis JL (1993) The effects of immobilization of long segments of the spine on the adjacent and distal facet force and lumbosacral motion. Spine 18:2471–9

    Article  CAS  PubMed  Google Scholar 

  22. Ha KY, Schendel MJ, Lewis JL, Ogilvie JW (1993) Effect of immobilization and configuration on lumbar adjacent-segment biomechanics. J Spinal Disord 6:99–105

    Article  CAS  PubMed  Google Scholar 

  23. Korovessis P, Papazisis Z, Koureas G, Lambiris E (2004) Rigid, semirigid versus dynamic instrumentation for degenerative lumbar spinal stenosis: a correlative radiological and clinical analysis of short-term results. Spine 29:735–42

    Article  PubMed  Google Scholar 

  24. Zdeblick TA (1993) A prospective, randomized study of lumbar fusion. Preliminary results. Spine 18:983–91

    Article  CAS  PubMed  Google Scholar 

  25. Kabins MB, Weinstein JN, Spratt KF, Found EM, Goel VK, Woody J, Sayre HA (1992) Isolated L4-L5 fusions using the variable screw placement system: unilateral versus bilateral. J Spinal Disord 5:39–49

    Article  CAS  PubMed  Google Scholar 

  26. Yücesoy K, Yüksel KZ, Baek S, Sonntag VK, Crawford NR (2008) Biomechanics of unilateral compared with bilateral lumbar pedicle screw fixation for stabilization of unilateral vertebral disease. J Neurosurg Spine 8:44–51

    Article  PubMed  Google Scholar 

  27. Chen HH, Cheung HH, Wang WK, Li A, Li KC (2005) Biomechanical analysis of unilateral fixation with interbody cages. Spine 30:E92–6

    Article  PubMed  Google Scholar 

  28. Slucky AV, Brodke DS, Bachus KN, Droge JA, Braun JT (2006) Less invasive posterior fixation method following transforaminal lumbar interbody fusion: a biomechanical analysis. Spine J 6:78–85

    Article  PubMed  Google Scholar 

  29. Aoki Y, Yamagata M, Nakajima F, Ikeda Y, Takahashi K (2009) Posterior migration of fusion cages in degenerative lumbar disease treated with transforaminal lumbar interbody fusion: a report of three patients. Spine 34:E54–8

    Article  PubMed  Google Scholar 

  30. Aoki Y, Yamagata M, Nakajima F, Ikeda Y, Shimizu K, Yoshihara M, Iwasaki J, Toyone T, Nakagawa K, Nakajima A, Takahashi K, Ohtori S (2010) Examining risk factors for posterior migration of fusion cages following transforaminal lumbar interbody fusion: a possible limitation of unilateral pedicle screw fixation. J Neurosurg Spine 13:381–7

    Article  PubMed  Google Scholar 

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Acknowledgments

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflicts of interest

The authors had no conflicts of interest to declare in relation to this article.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Second Affiliated Hospital, Medical College of Zhejiang University, NO.88 Jiefang Road, Hangzhou, 310009, People’s Republic of China

    Zengfeng Xin & Weixu Li

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  1. Zengfeng Xin
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  2. Weixu Li
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Correspondence to Weixu Li.

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Xin, Z., Li, W. Unilateral versus bilateral pedicle screw fixation in short-segment lumbar spinal fusion: a meta-analysis of randomised controlled trials. International Orthopaedics (SICOT) 40, 355–364 (2016). https://doi.org/10.1007/s00264-015-2842-3

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  • DOI: https://doi.org/10.1007/s00264-015-2842-3

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