Successful outcomes of unilateral vs bilateral pedicle screw fixation for lumbar interbody fusion: A meta-analysis with evidence grading

doi:10.12998/wjcc.v10.i36.13337

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World Journal of Clinical Cases

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Meta-Analysis

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.

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

ARTICLE HIGHLIGHTS

Research background

The use of unilateral pedicle screw (UPS) or bilateral pedicle screw (BPS) fixation for lumbar degenerative diseases remains controversial.

Research motivation

To provide objective evidence for the selection of UPS or BPS fixation for lumbar degenerative diseases.

Research objectives

To compare the efficacy and safety of UPS and BPS fixation in patients with lumbar degenerative diseases.

Research methods

We used meta-analysis to systematically review the current evidence.

Research results

UPS had slightly lower effects on fusion rate, which was the main contribution of this meta-analysis, and similar complication rates, Δ visual analog scale, and Δ Oswestry disability index. In contrast, there was a significant difference in Δ Japanese Orthopedic Association (JOA) score, total blood loss, operation time, and length of hospital stay.

Research conclusions

Unilateral fixation is less effective than bilateral fixation regarding fusion rate after lumbar interbody fusion. However, JOA, total blood loss, operation time, and length of stay were improved for unilateral fixation.

Research perspectives

To clarify whether UPS has the same reliability and effectiveness as BPS, longer follow-up and more clinical trials, especially RCTs, are required to provide stronger evidence regarding this observation. Further multicenter studies with more patients are required to obtain more reliable results.