Abstract
BackgroundTo investigate whether unilateral pedicle screw fixation is superior than bilateral pedicle screw fixation for lumbar degenerative diseases.MethodsElectronic databases including PubMed, Embase, and the Cochrane Library up to August 2018 were searched. All the high-quality randomized controlled trials (RCTs) and prospective clinical controlled studies comparing the unilateral pedicle screw fixation and bilateral pedicle screw fixation for lumbar degenerative diseases were enrolled in this study. Fusion rate was the main outcome. Stata 12.0 was used for the meta-analysis.ResultsTwelve RCTs including 808 patients (unilateral pedicle screw fixation = 393, bilateral pedicle screw fixation = 415) were included in our meta-analysis. There was a significant difference between unilateral pedicle screw fixation and bilateral pedicle screw fixation in terms of the fusion rate (risk ratio (RR) = 0.96, 95%CI [0.92, 1.00], P = 0.073), visual analog scale (VAS) at final follow-up, Oswestry Disability Index (ODI), Japanese Orthopedic Association scores (JOA), short-form health survey (SF-36), and length of hospital stay. Compared with bilateral pedicle screw fixation, unilateral pedicle screw fixation was associated with a reduction of the total blood loss and operation time (P < 0.05). Unilateral pedicle screw fixation was associated with an increase of the cage migration than bilateral pedicle screw fixation (17.1% vs 7.1%, RR = 2.40, 95% CI = 1.17 to 4.93; P = 0.017).ConclusionsUnilateral pedicle screw fixation and bilateral pedicle screw fixation has similar fusion rate when treating for lumbar degenerative diseases. Our meta-analysis suggested that compared with bilateral pedicle screw fixation, unilateral pedicle screw fixation significantly reduced total blood loss and operation time for lumbar degenerative diseases. The use of unilateral pedicle screw for lumbar degenerative diseases increases the cage migration.
Highlights
Lumbar spinal fusion is recognized as an effective surgical procedure for degenerative lumbar diseases [1]
Japanese Orthopedic Association scores (JOA) score was reported in four studies, and there was a large heterogeneity between the included studies (I2 = 48.2%, P = 0.122; Fig. 7), the results show that there was no significant difference in the JOA score between the unilateral and bilateral group (WMD =0.13, 95% Confidence interval (CI) = − 0.69 to 0.95; P = 0.751)
The results showed that unilateral pedicle screw fixation was associated with an increase of the cage migration than bilateral pedicle screw fixation (17.1% vs 7.1%, Risk ratio (RR) = 2.40, 95% CI = 1.17 to 4.93; P = 0.017, Fig. 13)
Summary
Lumbar spinal fusion is recognized as an effective surgical procedure for degenerative lumbar diseases [1]. Lumbar fusion can achieve solid arthrodesis, immobilizing the unstable segment and degenerated intervertebral disk area [2]. Bilateral pedicle screw fixation after interbody fusion is regarded as a standard surgical method for degenerative lumbar diseases. In 1991, Goel et al [4] revealed that unilateral pedicle screw fixation could reduce the effects of stress shielding on the fixed vertebrae and avoid adjacent intervertebral disc degeneration. Some scholars reported that unilateral pedicle screw fixation is sufficient to maintain the stability of the spine. A previous biomechanical study revealed that the initial stability of unilateral pedicle screw fixation may be inadequate to obtain improved surgical outcomes. To investigate whether unilateral pedicle screw fixation is superior than bilateral pedicle screw fixation for lumbar degenerative diseases
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