Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2022; 10(36): 13337-13348
Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13337
Successful outcomes of unilateral vs bilateral pedicle screw fixation for lumbar interbody fusion: A meta-analysis with evidence grading
Lei Sun, Ai-Xian Tian, Jian-Xiong Ma, Xin-Long Ma
Lei Sun, Ai-Xian Tian, Jian-Xiong Ma, Xin-Long Ma, Orthopedic Research Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China
Author contributions: Sun L, Tian AX and Ma JX designed research, performed research, and wrote the paper; Ma XL was a major contributor in writing the manuscript and analyzed data, and all authors read and approved the final manuscript.
Supported by the Health Science and Technology of Tianjin Municipality, No. RC20204; Tianjin Institute of Orthopedics, No. 2019TJGYSKY03; and the National Natural Science Foundation of China, No. 818717771177226.
Conflict-of-interest statement: The authors declare no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Long Ma, MS, Professor, Orthopedic Research Institute, Tianjin Hospital, Tianjin University, No. 122 Munan Street, Heping District, Tianjin 300050, China. tianax1986@126.com
Received: August 19, 2022
Peer-review started: August 19, 2022
First decision: October 21, 2022
Revised: November 16, 2022
Accepted: December 5, 2022
Article in press: December 5, 2022
Published online: December 26, 2022
Processing time: 129 Days and 8.6 Hours
Abstract
BACKGROUND

Whether it’s better to adopt unilateral pedicle screw (UPS) fixation or to use bilateral pedicle screw (BPS) one for lumbar degenerative diseases is still controversially undetermined.

AIM

To make a comparison between UPS and BPS fixation as to how they work efficaciously and safely in patients suffering from lumbar degenerative diseases.

METHODS

We have searched a lot in the databases through 2020 with index terms such as “unilateral pedicle screw fixation” and “bilateral pedicle screw fixation.” Only randomized controlled trials and some prospective cohort studies could be found, yielding 15 studies. The intervention was unilateral pedicle screw fixation; Primarily We’ve got outcomes of complications and fusion rates. Secondarily, we’ve achieved outcomes regarding total blood loss, operative time, as well as length of stay. Softwares were installed and utilized for subgroup analysis, analyzing forest plots, sensitivity, heterogeneity, forest plots, publication bias, and risk of bias.

RESULTS

Fifteen previous cases of study including 992 participants have been involved in our meta-analysis. UPS had slightly lower effects on fusion rate [relative risk (RR) = 0.949, 95%CI: 0.910 to 0.990, P = 0.015], which contributed mostly to this meta-analysis, and similar complication rates (RR = 1.140, 95%CI: 0.792 to 1.640, P = 0.481), Δ visual analog scale [standard mean difference (SMD) = 0.178, 95%CI: -0.021 to 0.378, P = 0.080], and Δ Oswestry disability index (SMD = -0.254, 95%CI: -0.820 to 0.329, P = 0.402). In contrast, an obvious difference has been observed in Δ Japanese Orthopedic Association (JOA) score (SMD = 0.305, 95%CI: 0.046 to 0.563, P = 0.021), total blood loss (SMD = -1.586, 95%CI: -2.182 to -0.990, P = 0.000), operation time (SMD = -2.831, 95%CI: -3.753 to -1.909, P = 0.000), and length of hospital stay (SMD = -0.614, 95%CI: -1.050 to -0.179, P = 0.006).

CONCLUSION

Bilateral fixation is more effective than unilateral fixation regarding fusion rate after lumbar interbody fusion. However, JOA, operation time, total blood loss, as well as length of stay were improved for unilateral fixation.

Keywords: Unilateral pedicle screw fixation; Bilateral pedicle screw fixation; Meta-analysis; Spinal fusion surgery; Discectomy; Lumbar interbody fusion

Core Tip: This literature is not strongly conclusive regarding whether bilateral pedicle screw (BPS) fixation or unilateral pedicle screw (UPS) one is more efficacious and safe for patients with lumbar degenerative diseases. While BPS has been considered standard, it has been associated with excessive rigidity and clinically adverse effects clinically, for example, device-related osteoporosis, adjacent segment degeneration, and a higher risk of other complications. This was the first large scale meta-analysis comparing UPS and BPS. We found UPS to have a slightly more poor fusion rate, but significantly improved prognosis regarding several clinical outcomes, possibly associated with minimal invasion.