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European Spine Journal

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01-05-2014 | Review Article

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

Authors: Ying-Chao Han, Zhu-Qing Liu, Shan-Jin Wang, Li-Jun Li, Jun Tan

Published in: European Spine Journal | Issue 5/2014

Abstract

Purpose

Traditionally, lumbar spinal surgery is performed with bilateral pedicle screw fixation to provide stability as the fusion heals. However, many studies have reported that unilateral pedicle screw fixation is as effective as bilateral constructs. To compare the clinical outcomes, complications, and surgical trauma between the two techniques for treatment of degenerative lumbar diseases, we conducted a meta-analysis.

Methods

We searched MEDLINE, EMBASE, PubMed, Google Scholar, and Cochrane databases for relevant controlled studies up to August 2013 that compared unilateral with bilateral fixation for the treatment of degenerative lumbar diseases. We independently performed title/abstract screening and full-text screening. A random effects model was used for heterogeneous data; otherwise, a fixed effect model was used, pooling data using mean difference (MD) for continuous outcomes and odds ratio (OR) for dichotomous outcomes.

Results

A total of 12 articles (865 participants) were eligible. Overall, there were significant differences between the two groups for blood loss (MD = −171.73, 95 % CI = −281.70 to −61.76; p = 0.002), operation time (MD = −66.02, 95 % CI = −115.52 to −16.51; p = 0.009), and fusion rate (OR = 0.50, 95 % CI = 0.26–0.96; p = 0.004). However, there were no significant differences in hospital stay (MD = −4.44, 95 % CI = −13.37 to 4.50), ODI (MD = −0.09, 95 % CI = −0.59 to 0.42; p = 0.74), JOA (MD = 0.18, 95 % CI = −0.77 to 1.14; p = 0.71), VAS (MD = −0.04, 95 % CI = −0.16 to 0.08; p = 0.49), SF-36 (PF: MD = −1.11, 95 % CI = −4.38 to 2.17, p = 0.51; GH: MD = 1.22, 95 % CI = −2.17 to 4.60, p = 0.48; MH: MD = −0.22, 95 % CI = −3.83 to 3.38, p = 0.90) and complications (OR = 1.15, 95 % CI = 0.72–1.85; p = 0.56).

Conclusions

This meta-analysis shows that there was significantly less blood loss in unilateral group and less operating time; however, the fusion rate was significantly higher in the bilateral group. The outcomes of hospital stay, ODI, JOA, VAS, SF-36 score, and complications are similar in the two groups.

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Title: Comparison of unilateral versus bilateral pedicle screw fixation in degenerative lumbar diseases: a meta-analysis
Authors: Ying-Chao Han
Zhu-Qing Liu
Shan-Jin Wang
Li-Jun Li
Jun Tan
Publication date: 01-05-2014
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 5/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-014-3221-2

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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