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

Xianzhou Li, Chaoliang Lv, Tingzhen Yan

Department of Spine Surgery, Jining No.1 People’s Hospital, Shandong Academy of Medical Sciences, Jining, Shangdong, China (mainland)

Med Sci Monit 2015; 21:782-790

DOI: 10.12659/MSM.892593

Available online:

Published: 2015-03-16

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Material and Methods: After systematic review of published and unpublished literature, a meta-analysis was conducted to compare the 2 treatment strategies.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