A Meta-Analysis of Unilateral versus Bilateral Pedicle Screw Fixation in Minimally Invasive Lumbar Interbody Fusion

Abstract

Study DesignMeta-analysis.BackgroundBilateral pedicle screw fixation (PS) after lumbar interbody fusion is a widely accepted method of managing various spinal diseases. Recently, unilateral PS fixation has been reported as effective as bilateral PS fixation. This meta-analysis aimed to comparatively assess the efficacy and safety of unilateral PS fixation and bilateral PS fixation in the minimally invasive (MIS) lumbar interbody fusion for one-level degenerative lumbar spine disease.MethodsMEDLINE/PubMed, EMBASE, BIOSIS Previews, and Cochrane Library were searched through March 30, 2014. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on unilateral versus bilateral PS fixation in MIS lumbar interbody fusion that met the inclusion criteria and the methodological quality standard were retrieved and reviewed. Data on participant characteristics, interventions, follow-up period, and outcomes were extracted from the included studies and analyzed by Review Manager 5.2.ResultsSix studies (5 RCTs and 1 CCT) involving 298 patients were selected. There were no significant differences between unilateral and bilateral PS fixation procedures in fusion rate, complications, visual analogue score (VAS) for leg pain, VAS for back pain, Oswestry disability index (ODI). Both fixation procedures had similar length of hospital stay (MD = 0.38, 95% CI = −0.83 to 1.58; P = 0.54). In contrast, bilateral PS fixation was associated with significantly more intra-operative blood loss (P = 0.002) and significantly longer operation time (P = 0.02) as compared with unilateral PS fixation.ConclusionsUnilateral PS fixation appears as effective and safe as bilateral PS fixation in MIS lumbar interbody fusion but requires less operative time and causes less blood loss, thus offering a simple alternative approach for one-level lumbar degenerative disease.

Acetyl-L-Carnitine in the Treatment of Peripheral Neuropathic Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Nonetheless, one [ 11 ] of our included trials has clearly stated its normal distribution of the VAS data. Additionally, published systematic reviews [ 29 , 30 ] have consistently used mean and SD to analyze VAS. Forth, the length of follow-up was relatively short in those trials; the long-term impact of ALC is unknown.…”

Percutaneous thoracolumbar decompression combined with percutaneous pedicle screw fixation and fusion: a method for treating spinal degenerative pain in a biplane angiography suite with the avoidance of general anesthesia

“…Such a strategy has gained attention recently as the advantages of avoiding general anesthesia have become more appreciated (7,8). In addition, the exclusive utilization of slit incisions and image-guided percutaneous techniques markedly limited the amount of tissue dissection and blood loss (9,10). Such approaches allow a patient population traditionally neglected to undergo treatment for painful spinal conditions (11)(12)(13).…”

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

“…Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a popular and effective surgical technique for the treatment of degenerative lumbar disorders (DLD), including spondylolisthesis, lumbar spinal canal stenosis associated with deformities, and discogenic pain identified by provocative discography [ 1 – 4 ]. Compared with the traditional open surgery, MIS-TLIF has multiple advantages, such as the decreased approach-related muscle damage, lesser blood loss, lower postoperative pain, shorter length of hospital stay, and minor postoperative narcotic usage allowing for early activity [ 1 , 5 ]. Many previous studies have demonstrated that MIS-TLIF could achieve excellent clinical outcomes [ 6 – 9 ].…”