Abstract
Purpose: During surgical procedure on lumbar spondylolisthesis, the role of reducing slip remains controversial. The purpose of the present study was to compare fusion in situ with reduction in clinical and radiographic outcomes.Methods: A literature research was performed at PubMed, Embase, Web of Science, and Cochrane Library. After screening by two authors, ten articles were brought into this meta-analysis finally, and the quality was evaluated by the modified Newcastle–Ottawa Scale (NOS). Isthmic, moderate, and serious spondylolisthesis were all analyzed separately. Sensitivity analyses were performed for high-quality studies, and the publication bias was evaluated by the funnel plot.Results: Most criteria did not have statistical differences between reduction and fusion in situ groups. However, in reduction group, the union rate was significantly higher (P=0.008), the slippage was much improved (P<0.001) and the hospital stay was much shorter comparing to no-reduction group (P<0.001). Subgroup analysis (containing moderate and serious slip, or isthmic spondylolisthesis) and sensitivity analysis were all consistent with original ones, and the funnel plot indicated no obvious publication bias in this meta-analysis.Conclusions: Both reduction and fusion in situ for lumbar spondylolisthesis were related with good clinical results. Reduction led to higher rate of fusion, better radiographic slippage, and shorter hospital stay. After sufficient decompression, reduction did not incur additional risk of neurologic impairment compared with fusion in situ.
Highlights
Spondylolisthesis is defined as the forward slippage of one vertebra on another
A total of 1161 studies were excluded for duplication or not related to spondylolisthesis
The quality of eight retrospective articles were evaluated by modified Newcastle–Ottawa Scale (NOS), and other two randomized controlled trial (RCT) were defined as high-quality studies directly
Summary
Spondylolisthesis is defined as the forward slippage of one vertebra on another. Stability reconstruction and neural decompression have been widely considered as the effective treatment for spondylolisthesis [1]. To achieve these aims, various fusion methods with different surgical approaches have been used, such as anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), and transforaminal lumbar interbody fusion (TLIF) [2]. The main surgical strategies for treating spondylolisthesis include spinal fusion in situ and spinal fusion with reduction. Fusion in situ means that the vertebras will be fused ‘where it is’ with little or no correction of the spine; while fusion with reduction suggests that the slippage will be reduced or realigned during the surgery (Figure 1). Despite the evolution of surgical treatment procedures, it still remains controversial whether the management of reducing the spondylolisthesis is necessary [1,4,5]
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