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Unilateral versus Bilateral Instrumentation in Spinal Surgery: A Systematic Review.

Molinari RW, Saleh A, Molinari R, Hermsmeyer J, Dettori JR - Global Spine J (2015)

Bottom Line: Clinical Questions (1) What is the comparative efficacy of unilateral instrumentation compared with bilateral instrumentation in spine surgery?(2) What is the safety of unilateral instrumentation compared with bilateral instrumentation in spine surgery?Conclusions The existing literature does not identify significant differences in clinical outcomes, union rates, and complications when unilateral instrumentation is used for degenerative pathologic conditions in the lumbar spine.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, University of Rochester, Rochester, New York, United States.

ABSTRACT
Study Design Systematic review. Clinical Questions (1) What is the comparative efficacy of unilateral instrumentation compared with bilateral instrumentation in spine surgery? (2) What is the safety of unilateral instrumentation compared with bilateral instrumentation in spine surgery? Methods Electronic databases and reference lists of key articles were searched up to September 30, 2014, to identify studies reporting the comparative efficacy and safety of unilateral versus bilateral instrumentation in spine surgery. Studies including recombinant human bone morphogenetic protein 2 as adjunct therapy and those with follow-up of less than 2 years were excluded. Results Ten randomized controlled trials met the inclusion criteria: five compared unilateral with bilateral instrumentation using open transforaminal or posterior lumbar interbody fusion (TLIF/PLIF), one used open posterolateral fusion, and four used minimally invasive TLIF/PLIF. There were no significant differences between unilateral and bilateral screw instrumentation with respect to nonunion, low back or leg pain scores, Oswestry Disability Index, reoperation, or complications. Conclusions The existing literature does not identify significant differences in clinical outcomes, union rates, and complications when unilateral instrumentation is used for degenerative pathologic conditions in the lumbar spine. The majority of published reports involve single-level lumbar unilateral instrumentation.

No MeSH data available.


Related in: MedlinePlus

Preoperative radiographs show L4–5 grade 1 degenerative spondylolisthesis (A, B). Preoperative magnetic resonance imaging demonstrates L4–5 low-grade degenerative spondylolisthesis with severe spinal stenosis (C, D). Three-year postoperative anteroposterior and lateral radiographs demonstrating solid bilateral fusion without loosening of unilateral fixation (E, F).
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FI1500006sr-12: Preoperative radiographs show L4–5 grade 1 degenerative spondylolisthesis (A, B). Preoperative magnetic resonance imaging demonstrates L4–5 low-grade degenerative spondylolisthesis with severe spinal stenosis (C, D). Three-year postoperative anteroposterior and lateral radiographs demonstrating solid bilateral fusion without loosening of unilateral fixation (E, F).

Mentions: The preoperative radiographs showed L4–L5 grade 1 degenerative spondylolisthesis (Fig. 12A, B). The preoperative magnetic resonance imaging demonstrated L4–L5 low-grade degenerative spondylolisthesis with severe spinal stenosis (Fig. 12C, D).


Unilateral versus Bilateral Instrumentation in Spinal Surgery: A Systematic Review.

Molinari RW, Saleh A, Molinari R, Hermsmeyer J, Dettori JR - Global Spine J (2015)

Preoperative radiographs show L4–5 grade 1 degenerative spondylolisthesis (A, B). Preoperative magnetic resonance imaging demonstrates L4–5 low-grade degenerative spondylolisthesis with severe spinal stenosis (C, D). Three-year postoperative anteroposterior and lateral radiographs demonstrating solid bilateral fusion without loosening of unilateral fixation (E, F).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4472301&req=5

FI1500006sr-12: Preoperative radiographs show L4–5 grade 1 degenerative spondylolisthesis (A, B). Preoperative magnetic resonance imaging demonstrates L4–5 low-grade degenerative spondylolisthesis with severe spinal stenosis (C, D). Three-year postoperative anteroposterior and lateral radiographs demonstrating solid bilateral fusion without loosening of unilateral fixation (E, F).
Mentions: The preoperative radiographs showed L4–L5 grade 1 degenerative spondylolisthesis (Fig. 12A, B). The preoperative magnetic resonance imaging demonstrated L4–L5 low-grade degenerative spondylolisthesis with severe spinal stenosis (Fig. 12C, D).

Bottom Line: Clinical Questions (1) What is the comparative efficacy of unilateral instrumentation compared with bilateral instrumentation in spine surgery?(2) What is the safety of unilateral instrumentation compared with bilateral instrumentation in spine surgery?Conclusions The existing literature does not identify significant differences in clinical outcomes, union rates, and complications when unilateral instrumentation is used for degenerative pathologic conditions in the lumbar spine.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, University of Rochester, Rochester, New York, United States.

ABSTRACT
Study Design Systematic review. Clinical Questions (1) What is the comparative efficacy of unilateral instrumentation compared with bilateral instrumentation in spine surgery? (2) What is the safety of unilateral instrumentation compared with bilateral instrumentation in spine surgery? Methods Electronic databases and reference lists of key articles were searched up to September 30, 2014, to identify studies reporting the comparative efficacy and safety of unilateral versus bilateral instrumentation in spine surgery. Studies including recombinant human bone morphogenetic protein 2 as adjunct therapy and those with follow-up of less than 2 years were excluded. Results Ten randomized controlled trials met the inclusion criteria: five compared unilateral with bilateral instrumentation using open transforaminal or posterior lumbar interbody fusion (TLIF/PLIF), one used open posterolateral fusion, and four used minimally invasive TLIF/PLIF. There were no significant differences between unilateral and bilateral screw instrumentation with respect to nonunion, low back or leg pain scores, Oswestry Disability Index, reoperation, or complications. Conclusions The existing literature does not identify significant differences in clinical outcomes, union rates, and complications when unilateral instrumentation is used for degenerative pathologic conditions in the lumbar spine. The majority of published reports involve single-level lumbar unilateral instrumentation.

No MeSH data available.


Related in: MedlinePlus