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Unilateral versus bilateral pedicle screw fixation of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF): a meta-analysis of randomized controlled trials.

Wang L, Wang Y, Li Z, Yu B, Li Y - BMC Surg (2014)

Bottom Line: A few studies focused on unilateral or bilateral pedicle screw (PS) fixation of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) to treat lumbar degenerative diseases have been published.Unilateral pedicle screw fixation was associated with less blood loss (WMD = -87.83; 95% CI: -160.70 to -14.96; P =0.02).The existing evidence indicate that no superiority exists between the two fixation methods of MIS-TLIF in terms of functional outcome, fusion rate and complication rate, in spite of that unilateral pedicle screw fixation can achieve less blood loss than bilateral fixation.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan Hutong, Beijing 100730, China. wlliangwang@sina.com.

ABSTRACT

Background: A few studies focused on unilateral or bilateral pedicle screw (PS) fixation of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) to treat lumbar degenerative diseases have been published. There is still debate over whether one method is superior to another. A systematic review and meta-analysis of randomized controlled trials (RCT) was performed to compare the efficacy of the two methods.

Methods: We searched the established electronic literature databases of MEDLINE, EMBASE, Web of Science and the Cochrane Central Register of Controlled Trials databases for RCTs comparing the unilateral with bilateral pedicle screw fixation of MIS-TLIF. Pooled mean differences (MD) and odds ratios (OR) and with 95% CIs were calculated for the outcomes.

Results: Three RCTs were identified and analyzed. The results showed that there is no significant difference between the two methods in terms of postoperative VAS-BP score (WMD = -0.09; 95% CI: -0.69 to 0.51; P =0.78), ODI (WMD, -0.09; 95% CI -5.85 to 5.67; P =0.98), fusion rate (OR = 2.99; 95% CI 0.55 to 16.38; P = 0.21) or complication rate (OR = 1.61, 95% CI: 0.49 to 5.37; P =0.43). Unilateral pedicle screw fixation was associated with less blood loss (WMD = -87.83; 95% CI: -160.70 to -14.96; P =0.02).

Conclusions: The existing evidence indicate that no superiority exists between the two fixation methods of MIS-TLIF in terms of functional outcome, fusion rate and complication rate, in spite of that unilateral pedicle screw fixation can achieve less blood loss than bilateral fixation.

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Related in: MedlinePlus

Flow chart of eligibility selection.
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Fig1: Flow chart of eligibility selection.

Mentions: The details of literature search and selection are displayed in the Figure 1. We identified 340 potentially relevant citations from the initial literature search. After independent review the titles and abstracts of all potential articles, three randomized controlled trials (RCTs) comparing unilateral pedicle screw fixation with bilateral fixation for MIS-TLIF [15–17] were finally identified. All selected studies were in English and all were published in 2013. All three RCT performed their MIS-TLIF with the assistance of Sextant system (Medtronic, USA). The study carried out by Un Yong Choi et al. [15] did not provide data on the Standard Deviation (SD) of constant score. The detailed characteristics of these studies are demonstrated in Tables 2 and 3.Figure 1


Unilateral versus bilateral pedicle screw fixation of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF): a meta-analysis of randomized controlled trials.

Wang L, Wang Y, Li Z, Yu B, Li Y - BMC Surg (2014)

Flow chart of eligibility selection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4233064&req=5

Fig1: Flow chart of eligibility selection.
Mentions: The details of literature search and selection are displayed in the Figure 1. We identified 340 potentially relevant citations from the initial literature search. After independent review the titles and abstracts of all potential articles, three randomized controlled trials (RCTs) comparing unilateral pedicle screw fixation with bilateral fixation for MIS-TLIF [15–17] were finally identified. All selected studies were in English and all were published in 2013. All three RCT performed their MIS-TLIF with the assistance of Sextant system (Medtronic, USA). The study carried out by Un Yong Choi et al. [15] did not provide data on the Standard Deviation (SD) of constant score. The detailed characteristics of these studies are demonstrated in Tables 2 and 3.Figure 1

Bottom Line: A few studies focused on unilateral or bilateral pedicle screw (PS) fixation of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) to treat lumbar degenerative diseases have been published.Unilateral pedicle screw fixation was associated with less blood loss (WMD = -87.83; 95% CI: -160.70 to -14.96; P =0.02).The existing evidence indicate that no superiority exists between the two fixation methods of MIS-TLIF in terms of functional outcome, fusion rate and complication rate, in spite of that unilateral pedicle screw fixation can achieve less blood loss than bilateral fixation.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan Hutong, Beijing 100730, China. wlliangwang@sina.com.

ABSTRACT

Background: A few studies focused on unilateral or bilateral pedicle screw (PS) fixation of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) to treat lumbar degenerative diseases have been published. There is still debate over whether one method is superior to another. A systematic review and meta-analysis of randomized controlled trials (RCT) was performed to compare the efficacy of the two methods.

Methods: We searched the established electronic literature databases of MEDLINE, EMBASE, Web of Science and the Cochrane Central Register of Controlled Trials databases for RCTs comparing the unilateral with bilateral pedicle screw fixation of MIS-TLIF. Pooled mean differences (MD) and odds ratios (OR) and with 95% CIs were calculated for the outcomes.

Results: Three RCTs were identified and analyzed. The results showed that there is no significant difference between the two methods in terms of postoperative VAS-BP score (WMD = -0.09; 95% CI: -0.69 to 0.51; P =0.78), ODI (WMD, -0.09; 95% CI -5.85 to 5.67; P =0.98), fusion rate (OR = 2.99; 95% CI 0.55 to 16.38; P = 0.21) or complication rate (OR = 1.61, 95% CI: 0.49 to 5.37; P =0.43). Unilateral pedicle screw fixation was associated with less blood loss (WMD = -87.83; 95% CI: -160.70 to -14.96; P =0.02).

Conclusions: The existing evidence indicate that no superiority exists between the two fixation methods of MIS-TLIF in terms of functional outcome, fusion rate and complication rate, in spite of that unilateral pedicle screw fixation can achieve less blood loss than bilateral fixation.

Show MeSH
Related in: MedlinePlus