Unilateral versus Bilateral Pedicle Screw Fixation for Degenerative Lumbar Diseases: A Meta-Analysis of 10 Randomized Controlled Trials

Abstract

BackgroundThe common and effective treatment for degenerative lumbar diseases is lumbar spinal fusion. Controversy still exists on the choice for instrumentation with spinal fusion procedures. Therefore, we conducted this meta-analysis exclusively of RCTs to compare the clinical outcomes of patients receiving bilateral versus unilateral pedicle screw fixation (PSF).Material/MethodsAfter systematic review of published and unpublished literature, a meta-analysis was conducted to compare the 2 treatment strategies. The methodological quality of the literature was assessed using the PEDro critical appraisal tool.ResultsData synthesis showed less blood loss (P<0.001) and shorter operative time (P<0.001) in patients receiving unilateral PSF compared to bilateral PSF. However, there was no significant difference in fusion rates and functional outcomes between the 2 groups.ConclusionsThe meta-analysis indicated no significant difference in fusion rates and functional outcomes between the 2 treatment procedures, but unilateral PS fixation reduced blood loss and operative time.

Unilateral Pedicle Screw Fixation with Bone Graft vs. Bilateral Pedicle Screw Fixation with Bone Graft or Cage: A Comparative Study

“…In our study, based on an average of 2.5 years follow-up, interbody fusion rates were 96.7%, 96.8%, and 94.1% in the UPSFB group, BPSFB group, and BPSFC group, respectively, and there was no significant difference among the 3 groups regarding interbody fusion rate. Similarly, a recent meta-analysis of RCTs reported fusion rates of 90.6% (230/254) and 94.0% (251/267) in unilateral and bilateral pedicle screw fixation groups, respectively, which were not significantly different [ 1 ]. In another study, fusion rates were 92.2% (249/270) in the unilateral group and 96.0% (264/275) in the bilateral group, without significant difference [ 10 ], and there was no significant difference among the 3 surgical procedures in reoperation rate and patient satisfaction.…”

“…Lumbar pedicle screw fixation and interbody fusion is a commonly used and effective surgical method to treat single-level lumbar degenerative diseases (LDD), such as spondylolisthesis, discogenic pain, and lumbar spinal canal stenosis associated with deformities [ 1 , 2 ]. Bilateral pedicle screw fixation and interbody fusion with cage (BPSFC) is widely used for managing lumbar spinal fusion [ 3 – 6 ].…”

“…Also, it may mean greater medical costs, thus increasing economic burden to patients living in poor areas. To reduce these problems some researchers have performed unilateral pedicle screw fixation and interbody fusion surgery, which has obtained satisfactory clinical outcomes [ 1 , 7 – 10 ].…”

Minimally Invasive Unilateral vs. Bilateral Pedicle Screw Fixation and Lumbar Interbody Fusion in Treatment of Multi-Segment Lumbar Degenerative Disorders

“…Although MIS-TLIF is widely performed with the treatment of DLD, the choice for instrumentation with spinal fusion procedures remains controversial. In general, bilateral pedicle screw (BPS) fixation for MIS-TLIF is preferred as a standard procedure due to its rigid fixation, great biomechanical stability and good clinical results [ 9 , 10 ]. However, some studies have indicated that increased number of implants and excessive rigidity can lead to more adverse clinical effects, such as reducing fusion rate and adjacent segment degeneration [ 11 , 12 ].…”

Anterograde Fixation Module for Posterior Acetabular Column Fracture: Computer-Assisted Determination of Optimal Entry Point, Angle, and Length for Screw Insertion

“…Dual column fixation is considered to be important for joint stability and early mobilization in surgery [11,12]. We designed a plate-screw fixation model for both fractured columns of the acetabulum.…”