Unilateral versus Bilateral Pedicle Screw Fixation for Degenerative Lumbar Diseases: A Meta-Analysis of 10 Randomized Controlled Trials

Abstract: Background: The common and effective treatment for degenerative lumbar diseases is lumbar spinal fusion. Controversy still exists on the choice for instrumentation with spinal fusion procedures. Therefore, we conducted this meta-analysis exclusively of RCTs to compare the clinical outcomes of patients receiving bilateral versus unilateral pedicle screw fixation (PSF).
Material and Methods: After systematic review of published and unpublished literature, a meta-analysis was conducted to compare the 2 treatment strategies. The methodological quality of the literature was assessed using the PEDro critical appraisal tool.
Results: Data synthesis showed less blood loss (P<0.001) and shorter operative time (P<0.001) in patients receiving unilateral PSF compared to bilateral PSF. However, there was no significant difference in fusion rates and functional outcomes between the 2 groups.
Conclusions: The meta-analysis indicated no significant difference in fusion rates and functional outcomes between the 2 treatment procedures, but unilateral PS fixation reduced blood loss and operative time.

Keywords: Hospitalization, Blood Loss, Surgical, Length of Stay, operative time, Pedicle Screws - adverse effects, Postoperative Care, Randomized Controlled Trials as Topic