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Meta-Analysis
. 2014 Nov 6:14:87.
doi: 10.1186/1471-2482-14-87.

Unilateral versus bilateral pedicle screw fixation of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF): a meta-analysis of randomized controlled trials

Liang Wang, Yipeng Wang  1 , Zhengyao Li, Bin Yu, Ye Li
Affiliations
Meta-Analysis

Unilateral versus bilateral pedicle screw fixation of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF): a meta-analysis of randomized controlled trials

Liang Wang et al. BMC Surg. .

Abstract

Background: A few studies focused on unilateral or bilateral pedicle screw (PS) fixation of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) to treat lumbar degenerative diseases have been published. There is still debate over whether one method is superior to another. A systematic review and meta-analysis of randomized controlled trials (RCT) was performed to compare the efficacy of the two methods.

Methods: We searched the established electronic literature databases of MEDLINE, EMBASE, Web of Science and the Cochrane Central Register of Controlled Trials databases for RCTs comparing the unilateral with bilateral pedicle screw fixation of MIS-TLIF. Pooled mean differences (MD) and odds ratios (OR) and with 95% CIs were calculated for the outcomes.

Results: Three RCTs were identified and analyzed. The results showed that there is no significant difference between the two methods in terms of postoperative VAS-BP score (WMD = -0.09; 95% CI: -0.69 to 0.51; P =0.78), ODI (WMD, -0.09; 95% CI -5.85 to 5.67; P =0.98), fusion rate (OR = 2.99; 95% CI 0.55 to 16.38; P = 0.21) or complication rate (OR = 1.61, 95% CI: 0.49 to 5.37; P =0.43). Unilateral pedicle screw fixation was associated with less blood loss (WMD = -87.83; 95% CI: -160.70 to -14.96; P =0.02).

Conclusions: The existing evidence indicate that no superiority exists between the two fixation methods of MIS-TLIF in terms of functional outcome, fusion rate and complication rate, in spite of that unilateral pedicle screw fixation can achieve less blood loss than bilateral fixation.

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Figures

Figure 1
Figure 1
Flow chart of eligibility selection.
Figure 2
Figure 2
Forest plot: weighted mean difference (WMD) in postoperative VAS-BP score and 95% CI for unilateral versus bilateral pedicle screw fixation of MIS-TLIF. No significant difference was found between the two groups.
Figure 3
Figure 3
Forest plot: weighted mean difference (WMD) in postoperative ODI and 95% CI for unilateral versus bilateral pedicle screw fixation of MIS-TLIF. No significant difference was found between the two groups.
Figure 4
Figure 4
Forest plot: weighted mean difference (WMD) in estimated blood loss and 95% CI for unilateral versus bilateral pedicle screw fixation of MIS-TLIF. Lower blood loss in the unilateral group was observed in this forest plot.
Figure 5
Figure 5
Forest plot: odds ratio (OR) in fusion rate and 95% CI for unilateral versus bilateral pedicle screw fixation of MIS-TLIF. No significant difference was found between the two groups.
Figure 6
Figure 6
Forest plot: odds ratio (OR) in complication rate and 95% CI for unilateral versus bilateral pedicle screw fixation of MIS-TLIF. No significant difference was found between the two groups.
See this image and copyright information in PMC

References

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Pre-publication history
    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2482/14/87/prepub

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