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

Abstract

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