Bilateral versus unilateral instrumentation in spinal surgery: Systematic review and trial sequential analysis of prospective studies.

Lumbar fusion surgical intervention is often followed by bilateral pedicle screw fixation. There has been increasing support for unilateral pedicle screw fixation in an attempt to reduce complications and costs. The following study assesses the efficacy and complications of bilateral versus unilateral pedicle screw fixation in open and minimally invasive lumbar interbody fusion techniques. A systematic review with meta-analysis and trial sequential analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recommendations. In comparison with existing meta-analyses, trial sequential analysis was implemented to reduce the potential for type I error. Of the 1310 citations screened, four observational studies and 13 randomised controlled trials were used comprising 574 bilateral cases and 549 unilateral cases. Statistical analysis showed no difference in fusion rates, total complications, dural tear rates, Visual Analogue Scale (VAS) score for back pain, VAS for leg pain, Oswestry Disability Index scores, and length of stay between bilateral and unilateral instrumentation. Unilateral instrumentation was significantly shorter in duration (P<0.00001) and led to significantly lower blood volume loss (P=0.0002). These results were the same for both open and minimally invasive surgical approaches. Unilateral pedicle screw fixation appears to have similar post-operative outcomes as bilateral fixation and improved efficacy in regards to procedure duration and blood volume loss.

Elevated intracellular calcium causes distinct mitochondrial remodelling and calcineurin-dependent fission in astrocytes.

Disruptions of mitochondrial dynamics have been implicated in the pathogenesis of neurodegenerative diseases. The regulation mechanisms of mitochondrial dynamics have not been fully elucidated; however, calcium has been suggested to play a role. In the present study, we examined the role of intracellular calcium in regulating mitochondrial morphology and motility in cortical astrocytes employing different concentrations of a calcium ionophore. High levels of calcium caused a dramatic reduction in mitochondrial length, the result of two distinct phenomena: mitochondrial remodelling (or "rounding") and fission. Quantitative analysis revealed that mitochondrial remodelling/rounding was the predominant process. In addition, mitochondrial motility was reduced, as reported previously in neurons. By contrast, prolonged, more modest levels of intracellular calcium resulted in a reduction in mitochondrial length without significant effects upon mitochondrial motility. This calcium-induced reduction in mitochondrial length was not affected by the presence of calcineurin inhibitors; however, when mitochondrial fission events were specifically examined, calcineurin inhibitors had a significant inhibitory effect. This suggests that changes in mitochondrial length were primarily due to mitochondrial remodelling as opposed to fission. In the present study, we have therefore dissected the effects of calcium on mitochondrial motility, remodelling and fission. Our results suggest independent mechanisms for regulating these processes.