Unilateral Pedicle Screw Fixation versus Bilateral Pedicle Screw Fixation for Single-Level Lumbar Degenerative Spine: A Systematic Review of Meta-analyses

A. Lychagin; V. Cherepanov; A. Garkavi; M. Lipina; I. Lisitzky; A. Korkunov; A. Zarov; A. Gritsyuk; M. Elizarov; G. Prah; Vyazankin Ivan

doi:10.3889/oamjms.2023.11649

Authors

A. Lychagin Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov First Moscow State Medical University, Moscow, Russia; Laboratory of Clinical Smart Nanotechnologies, Sechenov First Moscow State Medical University, Moscow, Russia
V. Cherepanov Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
A. Garkavi Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov First Moscow State Medical University, Moscow, Russia https://orcid.org/0009-0003-4707-1201
M. Lipina Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov First Moscow State Medical University, Moscow, Russia; Laboratory of Clinical Smart Nanotechnologies, Sechenov First Moscow State Medical University, Moscow, Russia
I. Lisitzky Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
A. Korkunov Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
A. Zarov Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
A. Gritsyuk Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
M. Elizarov Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov First Moscow State Medical University, Moscow, Russia https://orcid.org/0000-0002-4811-5718
G. Prah Ghana Health Service, Trauma and Specialist Hospital, Winneba, Ghana https://orcid.org/0009-0007-9643-299X
Vyazankin Ivan Department of Traumatology https://orcid.org/0000-0002-8020-2950

DOI:

https://doi.org/10.3889/oamjms.2023.11649

Keywords:

systematic review, lumbar spine, bilateral pedicle screw fixation, unilateral pedicle screw fixation

Abstract

AIM: The objectives of this study were to perform a systematic literature review based on studies that compare unilateral and bilateral pedicle screw fixation (PSF) in lumbosacral spine fusion to provide recommendations for the treatment of degenerative diseases of the spine, to identify studies with a more complete evidence base, and to identify possible limitations in available literature sources that require further research.

METHODS: A literature search was conducted in PubMed, Embase, and the Cochrane Library to identify studies that compare unilateral versus bilateral PSF versus interbody implant placement used the treatment of degenerative diseases of the lumbosacral spine. The study included meta-analyses that met the inclusion criteria. The quality of meta-analyses was evaluated with a measurement tool to assess systematic reviews (AMSTAR) score and the most relevant meta-analysis was determined by applying the Jadad algorithm.

RESULTS: Twelve studies fulfilled the eligibility criteria and were included in the study. The results of AMSTAR score ranged from 6 to 9, based on the results, four meta-analysis can be assigned to “middle” category and remained 8 to “upper” category. According to the results obtained, there was no significant difference between unilateral and bilateral PSF; however, unilateral fixation had advantages in the duration of surgical treatment and intraoperative blood loss.

СONCLUSION: According to this systematic review, unilateral PSF is an effective fixation method in the formation of lumbosacral spine fusion and has advantages in reducing the duration of surgical treatment and intraoperative blood loss compared to bilateral PSF.

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References

Moura DL, Lawrence D, Gabriel JP. Multilevel anterior lumbar interbody fusion combined with posterior stabilization in lumbar disc disease-prospective analysis of clinical and functional outcomes. Rev Bras Ortop (Sao Paulo). 2019;54(2):140-8. https://doi.org/10.1016/j.rbo.2017.11.006 PMid:31363259

Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: Techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ ATP, LLIF and ALIF. J Spine Surg. 2015;1(1):2-18. https://doi.org/10.3978/j.issn.2414-469X.2015.10.05 PMid:27683674

Schizas C, Michel J, Kosmopoulos V, Theumann N. Computer tomography assessment of pedicle screw insertion in percutaneous posterior transpedicular stabilization. Eur Spine J. 2007;16(5):613-7. https://doi.org/10.1007/s00586-006-0221-x PMid:16967297

Metzger MF, Robinson ST, Svet MT, Liu JC, Acosta FL. Biomechanical analysis of the proximal adjacent segment after multilevel instrumentation of the thoracic spine: Do hooks ease the transition? Global Spine J. 2016;6(4):335-43. https://doi.org/10.1055/s-0035-1563611 PMid:27190735

Lee CS, Hwang CJ, Lee SW, Ahn YJ, Kim YT, Lee DH, et al. Risk factors for adjacent segment disease after lumbar fusion. Eur Spine J. 2009;18(11):1637-43. https://doi.org/10.1007/s00586-009-1060-3 PMid:19533182

Sethi A, Lee S, Vaidya R. Transforaminal lumbar interbody fusion using unilateral pedicle screws and a translaminar screw. Eur Spine J. 2009;18(3):430-4. https://doi.org/10.1007/s00586-008-0825-4 PMid:19015896

Chen HH, Cheung HH, Wang WK, Li A, Li KC. Biomechanical analysis of unilateral fixation with interbody cages. Spine (Phila Pa 1976). 2005;30(4):E92-6. https://doi.org/10.1097/01.brs.0000153703.80747.16 PMid:15706329

Nomoto EK, Fogel GR, Rasouli A, Bundy JV, Turner AW. Biomechanical analysis of cortical versus pedicle screw fixation stability in TLIF, PLIF, and XLIF applications. Global Spine J. 2019;9(2):162-8. https://doi.org/10.1177/2192568218779991 PMid:30984495

Dahdaleh NS, Nixon AT, Lawton CD, Wong AP, Smith ZA, Fessler RG. Outcome following unilateral versus bilateral instrumentation in patients undergoing minimally invasive transforaminal lumbar interbody fusion: A single- center randomized prospective study. Neurosurg Focus. 2013;35(2):E13. https://doi.org/10.3171/2013.5.focus13171 PMid:23905951

Zhang K, Sun W, Zhao CQ, Li H, Ding W, Xie YZ, et al. Unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in two-level degenerative lumbar disorders: A prospective randomised study. Int Orthop. 2014;38(1):111-6. https://doi.org/10.1007/s00264-013-2026-y PMid:23917853

Muthu S, Chellamuthu G. How safe is unilateral pedicle screw fixation in lumbar fusion surgery for management of 2-level lumbar degenerative disorders compared with bilateral pedicle screw fixation? Meta-analysis of randomized controlled trials. World Neurosurg. 2020;140:357-68. https://doi.org/10.1016/j.wneu.2020.05.078 PMid:32428724

McKissack HM, Levene HB. Does the cage position in transforaminal lumbar interbody fusion determine unilateral versus bilateral screw placement?: A review of the literature. Asian Spine J. 2019;13(2):325-33. https://doi.org/10.31616/asj.2018.0087 PMid:30518200

Hou Y, Shen Y, Liu Z, Nie Z. Which posterior instrumentation is better for two-level anterior lumbar interbody fusion: Translaminar facet screw or pedicle screw? Arch Orthop Trauma Surg. 2013;133(1):37-42. https://doi.org/10.1007/s00402-012-1636-y PMid:23109094

Nayak AN, Gutierrez S, Billys JB, Santoni BG, Castellvi AE. Biomechanics of lateral plate and pedicle screw constructs in lumbar spines instrumented at two levels with laterally placed interbody cages. Spine J. 2013;13(10):1331-8. https://doi.org/10.1016/j.spinee.2013.03.048 PMid:23685215

Lin B, Lin QY, He MC, Liu H, Guo ZM, Lin KS. Clinical study on unilateral pedicle screw fixation and interbody fusion for the treatment of lumbar degenerative diseases under Quadrant system. Zhongguo Gu Shang. 2012;25(6):468-73.

PMid:23016381

Xie Y, Ma H, Li H, Ding W, Zhao C, Zhang P, et al. Comparative study of unilateral and bilateral pedicle screw fixation in posterior lumbar interbody fusion. Orthopedics. 2012;35(10):e1517-23. https://doi.org/10.3928/01477447-20120919-22 PMid:23027490

Xue H, Tu Y, Cai M. Comparison of unilateral versus bilateral instrumented transforaminal lumbar interbody fusion in degenerative lumbar diseases. Spine J. 2012;12(3):209-15. https://doi.org/10.1016/j.spinee.2012.01.010 PMid:22381573

Lin B, Xu Y, He Y, Zhang B, Lin Q, He M. Minimally invasive unilateral pedicle screw fixation and lumbar interbody fusion for the treatment of lumbar degenerative disease. Orthopedics. 2013;36(8):e1071-6. https://doi.org/10.3928/01477447-20130724-26 PMid:23937756

Wen J, Shi C, Yu L, Wang S, Xi Y, Ye X. Unilateral versus bilateral percutaneous pedicle screw fixation in oblique lumbar interbody fusion. World Neurosurg. 2020;134:e920-7. https:// doi.org/10.1016/j.wneu.2019.11.035 PMid:31733381

Shen X, Zhang H, Gu X, Gu G, Zhou X, He S. Unilateral versus bilateral pedicle screw instrumentation for single-level minimally invasive transforaminal lumbar interbody fusion. J Clin Neurosci. 2014;21(9):1612-6. https://doi.org/10.1016/j.jocn.2013.11.055 PMid:24814852

Dong J, Rong L, Feng F, Liu B, Xu Y, Wang Q, et al. Unilateral pedicle screw fixation through a tubular retractor via the Wiltse approach compared with conventional bilateral pedicle screw fixation for single-segment degenerative lumbar instability: A prospective randomized study. J Neurosurg Spine. 2014;20(1):53-9. https://doi.org/10.3171/2013.9.spine1392 PMid:24236667

Gu G, Zhang H, Fan G, He S, Meng X, Gu X, et al. Clinical and radiological outcomes of unilateral versus bilateral instrumentation in two-level degenerative lumbar diseases. Eur Spine J. 2015;24(8):1640-8. https://doi.org/10.1007/s00586-015-4031-x PMid:26002354

Toyone T, Ozawa T, Kamikawa K, Watanabe A, Matsuki K, Yamashita T, et al. Subsequent vertebral fractures following spinal fusion surgery for degenerative lumbar disease: A mean ten-year follow-up. Spine (Phila Pa 1976). 2010;35(21):1915-8.

https://doi.org/10.1097/brs.0b013e3181dc846c PMid:20838274

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. J Clin Epidemiol. 2009;62(10):1006-12. https://doi.org/10.1016/j.jlinepi.2009.06.005 PMid:19631508

Scheschuk JP, Mostello AJ, Lombardi NJ, Maltenfort MG, Freedman KB, Tjoumakaris FP. Levels of evidence in orthopaedic trauma literature. J Orthop Trauma. 2016;30(7):362-6. https://doi.org/10.1097/BOT.0000000000000557 PMid:27322200

Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: A measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7:10. https://doi.org/10.1186/1471-2288-7-10 PMid:17302989

Ren S, Hu Y. Comparison of unilateral versus bilateral pedicle screw fixation in transforaminal lumbar interbody fusion: A systematic review and meta-analysis of twelve randomized controlled trials. Int J Clin Exp Med. 2016;9(9):17113-27.

Xin Z, Li W. Unilateral versus bilateral pedicle screw fixation in short-segment lumbar spinal fusion: A meta-analysis of randomised controlled trials. Int Orthop. 2016;40(2):355-64. https://doi.org/10.1007/s00264-015-2842-3 PMid:26174053

Lu P, Pan T, Dai T, Chen G, Shi KQ. Is unilateral pedicle screw fixation superior than bilateral pedicle screw fixation for lumbar degenerative diseases: A meta-analysis. J Orthop Surg Res. 2018;13(1):296. https://doi.org/10.1186/s13018-018-1004-x PMid:30466462

Xiao SW, Jiang H, Yang LJ, Xiao ZM. Comparison of unilateral versus bilateral pedicle screw fixation with cage fusion in degenerative lumbar diseases: A meta-analysis. Eur Spine J. 2015;24(4):764-74. https://doi.org/10.1007/s00586-014-3717-9 PMid:25510516

Li X, Lv C, Yan T. Unilateral versus bilateral pedicle screw fixation for degenerative lumbar diseases: A meta-analysis of 10 randomized controlled trials. Med Sci Monit. 2015;21:782-90. https://doi.org/10.12659/MSM.892593 PMid:25774950

Molinari RW, Saleh A, Molinari R Jr., Hermsmeyer J, Dettori JR. Unilateral versus bilateral instrumentation in spinal surgery: A systematic review. Global Spine J. 2015;5(3):185-94. https://doi.org/10.1055/s-0035-1552986 PMid:26131385

Wang L, Wang Y, Li Z, Yu B, Li Y. Unilateral versus bilateral pedicle screw fixation of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF): A meta-analysis of randomized controlled trials. BMC Surg. 2014;14:87. https://doi.org/10.1186/1471-2482-14-87 PMid:25378083

Hu XQ, Wu XL, Xu C, Zheng XH, Jin YL, Wu LJ, et al. A systematic review and meta-analysis of unilateral versus bilateral pedicle screw fixation in transforaminal lumbar interbody fusion. PLoS One. 2014;9(1):e87501. https://doi.org/10.1371/journal.pone.0087501 PMid:24489929

Liu Z, Fei Q, Wang B, Lv P, Chi C, Yang Y, et al. A meta- analysis of unilateral versus bilateral pedicle screw fixation in minimally invasive lumbar interbody fusion. PLoS One. 2014;9(11):e111979. https://doi.org/10.1371/journal.pone.0111979

Liu H, Xu Y, Yang SD, Wang T, Wang H, Liu FY, et al. Unilateral versus bilateral pedicle screw fixation with posterior lumbar interbody fusion for lumbar degenerative diseases: A meta- analysis. Medicine (Baltimore). 2017;96(21):e6882. https://doi.org/10.1097/MD.0000000000006882 PMid:28538379

Ding W, Chen Y, Liu H, Wang J, Zheng Z. Comparison of unilateral versus bilateral pedicle screw fixation in lumbar interbody fusion: A meta-analysis. Eur Spine J. 2014;23(2):395-403. https://doi.org/10.1007/s00586-013-3100-2 PMid:24263802

Sun L, Tian AX, Ma JX, Ma XL. Successful outcomes of unilateral vs bilateral pedicle screw fixation for lumbar interbody fusion: A meta-analysis with evidence grading. World J Clin Cases. 2022;10(36):13337-48. https://doi.org/10.12998/wjcc.v10.i36.13337 PMid:36683615

Mao L, Zhao J, Dai KR, Hua L, Sun XJ. Bilateral decompression using a unilateral pedicle construct for lumbar stenosis. Int Orthop. 2014;38(3):573-8. https://doi.org/10.1007/s00264-013-2225-6 PMid:24337752

Fukushima M, Oshima Y, Yuzawa Y, Tanaka S, Inanami H. Clinical and radiographic analysis of unilateral versus bilateral instrumented one-level lateral lumbar interbody fusion. Sci Rep. 2020;10(1):3105. https://doi.org/10.1038/s41598-020-59706-9 PMid:32080245

Wang HW, Hu YC, Wu ZY, Wu HR, Wu CF, Zhang LS, et al. Minimally invasive transforaminal lumbar interbody fusion and unilateral fixation for degenerative lumbar disease. Orthop Surg. 2017;9(3):277-83. https://doi.org/10.1111/os.12345 PMid:28960820

Jadad AR, Cook DJ, Browman GP. A guide to interpreting discordant systematic reviews. CMAJ. 1997;156(10):1411-1416.

Chang TS, Chang JH, Wang CS, Chen HY, Cheng CW. Evaluation of unilateral cage-instrumented fixation for lumbar spine. J Orthop Surg Res. 2010;5:86. https://doi.org/10.1186/1749-799X-5-86 PMid:21070626

Huynh AM, Aubin CE, Rajwani T, Bagnall KM, Villemure I. Pedicle growth asymmetry as a cause of adolescent idiopathic scoliosis: A biomechanical study. Eur Spine J. 2007;16(4):523-9. https://doi.org/10.1007/s00586-006-0235-4 PMid:17031702