Unilateral versus bilateral pedicle screw fixation with posterior lumbar interbody fusion for lumbar degenerative diseases A meta-analysis

Background: Both unilateral pedicle screw fixation with posterior lumbar interbody fusion (PLIF) and bilateral pedicle screw fixation with PLIF are used to treat lumbar degenerative diseases (LDD). However, which one is a better treatment for LDD remains considerable controversy. Therefore, the focus of this meta-analysis was to assess the merits and shortcomings of efficacy of these 2 surgical procedures for LDD. Methods: An extensive search of literature was performed in Pubmed/MEDLINE, Embase, CNKI, and WANFANG databases on unilateral versus bilateral pedicle screw fixation with PLIF fusion for LDD, from January 2007 to January 2017 and language was restricted to Chinese or English. The following variables were extracted: blood loss, operation time, length of hospital stay, Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) and Oswestry disability index (ODI) scores, fusion rate, total complications, infection, dural injury, and nerve injury. Data analysis was conducted with RevMan 5.3 and STATA 12.0. Results: A total of 11 studies containing 844 patients were included in our study. The results showed that unilateral is better than bilateral pedicle screw fixation with PLIF in blood loss (P<.00001), operation time (P<.00001), the length of hospital stay (P=.003), and the final follow-up ODI scores (P=.04). However, there are no significant differences in JOA, VAS, and preoperative ODI scores. There are also no significant differences in fusion rate and complications (all P>.05). Conclusion: Based on our meta-analysis, our results suggest that both unilateral pedicle screw fixation with PLIF and bilateral pedicle screw fixation with PLIF for LDD have effective results in clinical outcomes. Both 2 methods may result in clinical improvement and similar outcomes of fusion rate and complications; However, compared with bilateral fixation, unilateral fixation produces more satisfactory efficacy in the blood loss and the operation time.