A Meta-analysis of unilateral pedicle screw plus contralateral translaminar facet screw and bilateral pedicle screw internal fixation for lumbar degenerative disease

English Keywords:Degenerative disease of the lumbar spine  Translaminar facet screws  Pedicle screws  Internal fixation  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To evaluate the efficacy of posterior decompression and fusion with unilateral pedicle screw plus contralateral translaminar facet screw(UPSFS) and bilateral pedicle screw(BPS) internal fixation for lumbar degenerative disease by a Meta-analysis system. Methods： Case-control studies about the treatment of lumbar degenerative diseases with UPSFS and BPS published on PubMed, Cochrane, Embase, CNKI, Wanfang and VIP databases from their establishment to January 2021 were searched. Literature screening was conducted according to inclusion and exclusion criteria. The Newcastle-Ottawa scale(NOS) was used to evaluate the quality of the included studies. Outcome index data were extracted, including pre-operative and the final follow-up scores of visual analogue scale(VAS)(low back and leg), Japanese Orthopaedic Association(JOA) scores, Oswestry disability index(ODI), and changes of intervertebral space height of the surgical segment, as well as the length of surgical incision, operative time, intraoperative blood loss, postoperative drainage volume, hospitalization cost, operative segmental fusion rate and complication rate. Meta-analysis was performed by Review Manager 5.3 after data collection. Results: Ten case-control studies were included, and all of them met the requirements for NOS evaluation. A total of 588 patients underwent internal fixation, including 291 patients in the intervention group(UPSFS internal fixation) and 297 in the control group(BPS internal fixation). Follow-up period ranged from 12 to 60 months. Results of Meta-analysis showed that there were significant differences between the two groups in VAS(leg) changes from baseline to the final follow-up [weighted mean difference(WMD)=-0.30, 95% confidence interval(CI)（-0.57, -0.03）], incision length [WMD=-4.49, 95%CI(-6.64, 2.55)], operative time[WMD=-32.61, 95%CI(-45.23, 19.99)], intraoperative blood loss[WMD=-152.63, 95%CI(-208.91, -96.35)], postoperative drainage volume[WMD=-186.21, 95%CI(-286.06, -86.36)] and hospitalization cost [WMD=-1.68, 95%CI(-2.27, -1.10)]. There were no significant differences between the two groups in VAS(low back)[WMD=-0.00, 95%CI(-0.26, 0.27)], JOA scores[WMD=0.26, 95%CI(-1.59, 2.11)], ODI[WMD=0.26, 95%CI (-1.59, 2.11)], intervertebral space height of the surgical segment[WMD=0.01, 95%CI(-0.61, 0.63)] changes from pre-operatively to the final follow-up. There were no significant differences in fusion rate[OR=0.31, 95%CI(0.10, 1.03)] and complication rate[OR=1.43, 95%CI (0.60, 3.40)] between the two groups at final follow-up. Conclusions: UPSFS internal fixation can achieve similar clinical efficacy and safety as BPS internal fixation, beside, it can improve the degree of leg pain more significantly, reduce surgical incision, operative time, intraoperative blood loss, postoperative drainage volume, and hospitalization costs.