Dataset Information

Unilateral versus bilateral pedicle screw fixation in lumbar fusion: A systematic review of overlapping meta-analyses.

ABSTRACT:

Objectives

To carry out a systematic review on the basis of overlapping meta-analyses that compare unilateral with bilateral pedicle screw fixation (PSF) in lumbar fusion to identify which study represents the current best evidence, and to provide recommendations of treatment on this topic.

Methods

A comprehensive literature search in PubMed, Embase, and the Cochrane Library databases was conducted to identify meta-analyses that compare unilateral with bilateral PSF in lumbar fusion. Only meta-analyses exclusively covering randomized controlled trials were included. Study quality was evaluated using the Oxford Levels of Evidence and Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Then, the Jadad decision algorithm was applied to select the highest-quality study to represent the current best evidence.

Results

A total of 9 studies with Level II of evidence fulfilled the eligibility criteria and were included. The scores of AMSTAR criteria for them varied from 5 to 9 (mean 7.78). The current best evidence detected no significant differences between unilateral and bilateral PSF for short-segment lumbar fusion in the functional scores, length of hospital stay, fusion rate, and complication rate. However, unilateral PSF involved a remarkable decrease in operative time and blood loss but increase of cage migration when compared with bilateral PSF.

Conclusions

According to this systematic review, unilateral PSF is an effective method of fixation for short-segment lumbar fusion, has the advantages of reduced operative time and blood loss over bilateral PSF, but increases the risk of cage migration.

SUBMITTER: Zhao Y

PROVIDER: S-EPMC6924673 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Publications

Unilateral versus bilateral pedicle screw fixation in lumbar fusion: A systematic review of overlapping meta-analyses.

Zhao Yachao Y Yang Sidong S Ding Wenyuan W

PloS one 20191220 12

<h4>Objectives</h4>To carry out a systematic review on the basis of overlapping meta-analyses that compare unilateral with bilateral pedicle screw fixation (PSF) in lumbar fusion to identify which study represents the current best evidence, and to provide recommendations of treatment on this topic.<h4>Methods</h4>A comprehensive literature search in PubMed, Embase, and the Cochrane Library databases was conducted to identify meta-analyses that compare unilateral with bilateral PSF in lumbar fusi ...[more]

PMID: 31860651

Similar Datasets

Project description:BackgroundTransforaminal lumbar interbody fusion (TLIF) has become one of the most widely used procedures for lumbar spinal disorders. However, it is still unclear whether TLIF with unilateral pedicle screw (PS) fixation is as effective as that with bilateral PS fixation. We performed a meta-analysis of the literatures and aimed to gain a better understanding of whether TLIF with unilateral PS fixation was safe and effective for lumbar diseases.Methodology/principal findingsWe systematically searched Ovid, Springer, and Medline databases for relevant randomized controlled trials (RCTs) that compared the clinical and radiological outcomes of unilateral versus bilateral PS fixation in TLIF. Risk of bias in included studies was assessed using the Cochrane Risk of Bias tool. We generated pooled risk ratios or weighted mean differences across studies. According to our predefined inclusion criteria, seven RCTs with a total of 441 patients were included in this study. Baseline characteristics were similar between the unilateral and bilateral groups. Our meta-analysis showed that no significant difference was detected between the two groups in terms of postoperative clinical function, fusion status, reoperation rate, complication rate, and hospital stay (p>0.05). Pooled estimates revealed that the unilateral group was associated with significantly reduced implant cost, operative time and blood loss (p<0.05).Conclusions/significancesOur meta-analysis suggested TLIF with unilateral PS fixation was as safe and effective as that with bilateral PS fixation for lumbar diseases in selected patients. Despite these findings, our meta-analysis was based on studies with small sample size and different study characteristics that might lead to the inconsistent results such as various functional outcomes among the included studies. Therefore, high-quality randomized controlled trials with larger sample size are also needed to further clarify these issues and to provide the long-term outcomes.

Project description:Background The purpose of this study was to compare the safety and efficacy of unilateral vs. bilateral pedicle screw fixation (BPSF) for lumbar degenerative diseases. Methods Electronic databases including PubMed, Web of science, the Cochrane Library, Scopus, MEDLINE, EMBASE, EBSCO were searched by computer. The deadline was set for June 1, 2022. This study included all high-quality randomized controlled trials (RCTs), prospective clinical controlled studies (PRO), and retrospective studies (Retro) that compared unilateral and bilateral pedicle screw fixation in the treatment of lumbar degenerative diseases. Revman5.3 software was used for meta-analysis after two researchers independently screened the literature, extracted data, and assessed the risk of bias in the study. Results Fourteen studies with a total of 1,086 patients were included. Compared with BPSF, unilateral pedicle screw fixation (UPSF) has shorter operation time and hospital time, and less blood loss and operation cost, operation time [SMD = −1.75, 95% CI (−2.46 to −1.03), P < 0.00001], hospital time [SMD = −1.10, 95% CI (−1.97 to −0.22), P = 0.01], Blood loss [SMD = −1.62, 95% CI (−2.42 to −0.82), P < 0.0001], operation cost [SMD = −14.03, 95% CI (−20.08 to −7.98), P < 0.00001], the ODI after bilateral pedicle screw fixation was lower, and the degree of lumbar dysfunction was lighter, [SMD = 0.19, 95% CI (0.05–0.33), P = 0.007], better fusion effect, fusion rate [RR=0.95, 95% CI (0.91–1.00), P = 0.04]. VAS-Low back pain [SMD = 0.07, 95% CI (−0.07–0.20), P = 0.35], VAS-Leg pain [SMD = 0.18, 95% CI (−0.00–0.36), P = 0.05], SF-36 [SMD = 0.00, 95% CI (−0.30–0.30), P = 1.00], complications rate [RR = 0.94, 95% CI (0.9154–1.63), P = 0.82], the overall difference was not statistically significant. Conclusions Currently limited evidence suggests that UPSF significantly reduces blood loss, significantly shortens the operative time and hospital stay, and reduces blood loss and costs. After BPSF, the ODI was lower, the degree of lumbar spine dysfunction was lower, and the fusion rate was significantly higher. The VAS, SF-36, and complications scores of the two groups were comparable, and there was no significant clinical difference.

Dataset Information

Unilateral versus bilateral pedicle screw fixation in lumbar fusion: A systematic review of overlapping meta-analyses.

Objectives

Methods

Results

Conclusions

Publications

Unilateral versus bilateral pedicle screw fixation in lumbar fusion: A systematic review of overlapping meta-analyses.

Similar Datasets

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