Unilateral pedicle screw fixation as effective as bilateral for TLIF, new meta-analysis finds

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Unilateral pedicle screw fixation (UPSF) is just as effective as bilateral pedicle screw fixation (BPSF) in transforaminal lumbar interbody fusion (TLIF) and may even reduce blood loss and operation time. This is according to a recent meta-analysis, the findings of which were published in the European Spine Journal by Xu Lin (Zigong Fourth People’s Hospital, Zigong, China) et al, which also showed however that UPSF may also result in more cage migration than BPSF.

The meta-analysis aimed to investigate whether UPSF is comparable to BPSF in TLIF for lumbar degenerative diseases.

Electronic literature databases such as PubMed, Web of Science, EMBASE, and the Cochrane Library were systematically searched up to September 2022.  Randomised controlled trials (RCTs) published in English that compared the efficacy of UPSF versus BPSF in TLIF were included.

The methodological quality was evaluated, relevant data was extracted, and suitable meta-analysis was carried out. Data of fusion rate, complications, cage migration, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI), total blood loss (TBL), operation time, and hospital stay were extracted and analysed. Pooled mean differences and risk ratio (RR) along with 95% confidence intervals (95% CI) were calculated for the results.

A total of 10 RCTs including 614 patients (UPSF= 294, BPSF= 320) were included in the meta-analysis. There were no significant differences in terms of fusion rate, VAS (VAS-BP and VAS-LP), ODI, complications, or hospital stay between UPSF and BPSF groups (p>0.05, respectively).

The UPSF group clearly had the advantage of less blood loss (standard mean difference [SMD]= −2.99, 95% CI [−4.54, −1.45], p= 0.0001) and operation time (SMD= −2.05, 95% CI [−3.10, −1], p= 0.0001). However, UPSF increased cage migration more than BPSF (10.7% vs. 4.8%, RR= 2.23, 95% CI [1.07, 4.65], p= 0.03).


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