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European Spine Journal
Published in: European Spine Journal 4/2015

01-04-2015 | Review Article

Comparison of unilateral versus bilateral pedicle screw fixation with cage fusion in degenerative lumbar diseases: a meta-analysis

Authors: Shan-Wen Xiao, Hua Jiang, Li-Jing Yang, Zeng-Ming Xiao

Published in: European Spine Journal | Issue 4/2015

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Abstract

Purpose

To compare the results between unilateral and bilateral pedicle screw (PS) fixation for the patients with degenerative lumbar diseases.

Methods

A systematic review and meta-analysis of cohort studies were conducted between unilateral PS fixation with cage fusion (unilateral group) and bilateral PS fixation with cage fusion (bilateral group) for the treatment of degenerative lumbar diseases from 1990 to June 2014. An extensive search of studies was performed in PubMed, Mediline, Embase and the Cochrane library. The following outcome measures were extracted: visual analogue scale (VAS), Oswestry disability index (ODI), Short-Form health survey (SF-36), fusion rate, complications, blood loss and operation time. Data analysis was conducted with RevMan 5.0.

Results

Eight RCTs involving 545 patients were included in this meta-analysis. The pooled analysis showed that there was no statistically significant difference in terms of the VAS, ODI and SF-36 scores, fusion rate [OR = 0.49 (0.23, 1.04), P = 0.06], complication rate(implant-related complication: P = 0.35, general complication rate: P = 0.71) and blood loss between two groups. However, there was less operation time in the unilateral group compared with bilateral group. Four patients (1.48 %) in unilateral group and one patient (0.36 %) in bilateral group were found cage migration, the difference did not achieve statistical significance (P = 0.213).

Conclusions

As compared to bilateral PS fixation with cage fusion, unilateral PS fixation with cage fusion achieves a similar VAS, ODI and SF-36 scores, fusion rate, complications and smaller surgical trauma. However, it is still uncertain whether unilateral pedicle screw fixation with cage fusion is as effective and safe as bilateral pedicle screw fixation with cage fusion.
Literature
1.
2.
Hashimoto T, Shigenobu K, Kanayama M, Harada M, Oha F, Ohkoshi Y, Tada H, Yamamoto K, Yamane S (2002) Clinical results of single-level posterior lumbar interbody fusion using the Brantigan I/F carbon cage filled with a mixture of local morselized bone and bioactive ceramic granules. Spine (Phila Pa 1976) 27:258–262CrossRef
3.
Kai Y, Oyama M, Morooka M (2004) Posterior lumbar interbody fusion using local facet joint autograft and pedicle screw fixation. Spine (Phila Pa 1976) 29:41–46CrossRef
4.
Trouillier H, Birkenmaier C, Rauch A, Weiler C, Kauschke T, Refior HJ (2006) Posterior lumbar interbody fusion (PLIF) with cages and local bone graft in the treatment of spinal stenosis. Acta Orthop Belg 72:460–466PubMed
5.
Suk KS, Lee HM, Kim NH, Ha JW (2000) Unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion. Spine 25:1843–1847CrossRefPubMed
6.
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 32:395–401CrossRefPubMed
7.
Mao L, Chen G, Xu X, Guo Z, Yang H (2013) Comparison of lumbar interbody fusion performed with unilateral or bilateral pedicle screw. Orthopedics 36:e489–e493CrossRefPubMed
8.
Furlan AD, Pennick V, Bombardier C, van Tulder M (2009) 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine 34:1929–1941CrossRefPubMed
9.
Xiaolong S, Lei W, Hailong Z, Xin G, Guangfei G, Shisheng H (2013) Radiographic analysis of one-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) with unilateral pedicle screw fixation for lumbar degenerative diseases. J Spinal Disord Tech. doi:10.​1097/​BSD.​0000000000000042​
10.
Shen X, Zhang H, Gu X, Gu G, Zhou X, He S (2014) Unilateral versus bilateral pedicle screw instrumentation for single-level minimally invasive transforaminal lumbar interbody fusion. J Clin Neurosci Off J Neurosurg Soc Australas 21(9):1612–1616
11.
Duncan JW, Bailey RA (2013) An analysis of fusion cage migration in unilateral and bilateral fixation with transforaminal lumbar interbody fusion. Eur Spine J 22:439–445CrossRefPubMedCentralPubMed
12.
Dahdaleh NS, Nixon AT, Lawton CD, Wong AP, A Z (2013) Outcome following unilateral versus bilateral instrumentation in patients undergoing minimally invasive 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
13.
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: clinical article. J Neurosurg Spine 17:153–159CrossRefPubMed
14.
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–e1523CrossRefPubMed
15.
Xue H, Tu Y, Cai M (2012) Comparison of unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in degenerative lumbar diseases. Spine J 12:209–215CrossRefPubMed
16.
Lin B, Xu Y, He Y, Zhang B, Lin Q, He M (2013) Minimally invasive unilateral pedicle screw fixation and lumbar interbody fusion for the treatment of lumbar degenerative disease. Orthopedics 36:e1071–e1076CrossRefPubMed
17.
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 38:111–116CrossRefPubMed
18.
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:E11CrossRefPubMed
19.
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: clinical article. J Neurosurg Spine 20:53–59CrossRefPubMed
20.
Lowe TG, Tahernia AD, O’Brien MF, Smith DA (2002) Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2-year results. J Spinal Disord Tech 15:31–38CrossRefPubMed
21.
Feng Z, Cao Y, Jiang C, Jiang X (2011) Short-term outcome of bilateral decompression via a unilateral paramedian approach for transforaminal lumbar interbody fusion with unilateral pedicle screw fixation. Orthopedics 34:364PubMed
22.
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 Tech 5:39–49CrossRef
23.
Harris BM, Hilibrand AS, Savas PE, Pellegrino A, Vaccaro AR, Siegler S, Albert TJ (2004) Transforaminal lumbar interbody fusion: the effect of various instrumentation techniques on the flexibility of the lumbar spine. Spine 29:E65–E70CrossRefPubMed
24.
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 6:78–85CrossRefPubMed
25.
Sethi A, Muzumdar AM, Ingalhalikar A, Vaidya R (2011) Biomechanical analysis of a novel posterior construct in a transforaminal lumbar interbody fusion model an in vitro study. Spine J 11:863–869CrossRefPubMed
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 8:44–51CrossRefPubMed
27.
Chen H, Cheung H, Wang W, Li A, Li K (2005) Biomechanical analysis of unilateral fixation with interbody cages. Spine 30:E92–E96CrossRefPubMed
28.
Han Y, Liu Z, Wang S, Li L, Tan J (2014) Comparison of unilateral versus bilateral pedicle screw fixation in degenerative lumbar diseases: a meta-analysis. Eur Spine J 23:974–984CrossRefPubMed
29.
Aoki Y, Yamagata M, Nakajima F, Ikeda Y, Shimizu K, Yoshihara M, Iwasaki J, Toyone T, Nakagawa K, Nakajima A (2010) Examining risk factors for posterior migration of fusion cages following transforaminal lumbar interbody fusion: a possible limitation of unilateral pedicle screw fixation: clinical article. J Neurosurg Spine 13:381–387CrossRefPubMed
30.
Smith AJ, Arginteanu M, Moore F, Steinberger A, Camins M (2010) Increased incidence of cage migration and nonunion in instrumented transforaminal lumbar interbody fusion with bioabsorbable cages: clinical article. J Neurosurg Spine 13:388–393CrossRefPubMed
31.
Abbushi A, Čabraja M, Thomale U, Woiciechowsky C, Kroppenstedt SN (2009) The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation. Eur Spine J 18:1621–1628CrossRefPubMedCentralPubMed
32.
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–E58CrossRefPubMed
33.
Knox CJB, Dai CJM III, Orchowski LJ (2011) Osteolysis in transforaminal lumbar interbody fusion with bone morphogenetic protein-2. Spine 36:672–676CrossRefPubMed
34.
Kimura H, Shikata J, Odate S, Soeda T, Yamamura S (2012) Risk factors for cage retropulsion after posterior lumbar interbody fusion: analysis of 1070 cases. Spine 37:1164–1169CrossRefPubMed
35.
Mroz TE, Wang JC, Hashimoto R, Norvell DC (2010) Complications related to osteobiologics use in spine surgery: a systematic review. Spine 35:S86–S104CrossRefPubMed
36.
37.
Beringer WF, Mobasser J (2006) Unilateral pedicle screw instrumentation for minimally invasive transforaminal lumbar interbody fusion. Neurosurg Focus 20:1–5
38.
Dickman CA, Yahiro MA, Lu H, Melkerson MN (1994) Surgical treatment alternatives for fixation of unstable fractures of the thoracic and lumbar spine: a meta-analysis. Spine 19:2266S–2273SCrossRefPubMed
39.
Haher TR, Merola A, Zipnick RI, Gorup J, Mannor D, Orchowski J (1995) Meta-analysis of surgical outcome in adolescent idiopathic scoliosis: a 35-year English literature review of 11,000 patients. Spine 20:1575–1584CrossRefPubMed
Metadata
Title
Comparison of unilateral versus bilateral pedicle screw fixation with cage fusion in degenerative lumbar diseases: a meta-analysis
Authors
Shan-Wen Xiao
Hua Jiang
Li-Jing Yang
Zeng-Ming Xiao
Publication date
01-04-2015
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 4/2015
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-014-3717-9

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