Comparative outcomes of unilateral and bilateral cage placement in lumbar interbody fusion: a systematic review and meta-analysis of randomized controlled trials
- Author:
Stavros STAMIRIS
1
;
Dimitrios STAMIRIS
;
Elissavet ANESTIADOU
;
Athanasios SARRIDIMITRIOU
;
Angeliki CHEVA
;
Antonia LOUKOUSIA
;
Vasilleios VRANGALAS
;
Pavlos CHRISTODOULOU
;
Christos KARAMPALIS
Author Information
- Publication Type:Review Article
- From:Asian Spine Journal 2026;20(2):372-387
- CountryRepublic of Korea
- Language:English
- Abstract: Lumbar interbody fusion is widely employed to treat degenerative spinal conditions. The procedure frequently involves the use of intervertebral cages to enhance segmental stability and facilitate spinal fusion. While bilateral cage placement has traditionally been the standard approach, recent studies have questioned its routine use. This meta-analysis aimed to determine whether unilateral cage placement offers comparable safety and efficacy to bilateral placement in lumbar interbody fusion. A comprehensive search of PubMed, Scopus, and Cochrane databases identified eight eligible randomized control trials involving 509 patients. The primary outcome was the spinal fusion rate. Secondary outcomes included surgery-related outcomes (operative time, estimated blood loss, length of stay), patientreported outcomes VAS, ODI, patient satisfaction), and complications. The analysis revealed no significant differences in successful spinal fusion rates between the two groups (p =0.41). Unilateral cage placement was significantly associated with shorter operation time (p <0.0001) and reduced estimated blood loss (p <0.0001). However, the length of hospital stay was not significantly affected by the number of cages used (p =0.05). Patient-reported outcomes, including Visual Analog Scale (VAS) for back pain (p =0.61), VAS for leg pain (p =0.64), Oswestry Disability Index score (p =0.18), and patient-reported rate of successful clinical outcomes (p =0.55), exhibited no substantial differences between the two groups. Patients in the unilateral group exhibited a lower overall risk of complications (p =0.03), but no difference in the risk of cage migration was noted between the two groups (p =0.97). Unilateral cage placement for lumbar interbody fusion is as effective as bilateral cage placement in achieving fusion, without compromising patient outcomes. Furthermore, it offers significant advantages, such as decreased operative time, blood loss, and complication risk.
