The surgical management of degenerative lumbar spondylolisthesis: a systematic review

Spine (Phila Pa 1976). 2007 Jul 15;32(16):1791-8. doi: 10.1097/BRS.0b013e3180bc219e.

Abstract

Study design: Systematic review.

Objective: To identify whether there is an advantage to instrumented or noninstrumented spinal fusion over decompression alone for patients with degenerative lumbar spondylolisthesis.

Summary of background data: The operative management of degenerative spondylolisthesis includes spinal decompression with or without instrumented or noninstrumented spinal fusion. Evidence on the operative management of degenerative spondylolisthesis is still divisive.

Methods: Relevant RCT and comparative observational studies between 1966 and June 2005 were identified. Abstracted outcomes included clinical outcome, reoperation rate, and solid fusion status. Analyses were separated into: 1) fusion versus decompression alone and 2) instrumented fusion versus noninstrumented fusion.

Results: Thirteen studies were included. The studies were generally of low methodologic quality. A satisfactory clinical outcome was significantly more likely with fusion than with decompression alone (relative risk, 1.40; 95% confidence interval, 1.04-1.89; P < 0.05). The use of adjunctive instrumentation significantly increased the probability of attaining solid fusion (relative risk, 1.37; 95% confidence interval, 1.07-1.75; P < 0.05), but no significant improvement in clinical outcome was recorded (relative risk, 1.19; 95% confidence interval, 0.92-1.54). There was a nonsignificant trend toward lower repeat operations with fusion compared with both decompression alone and instrumented fusion.

Conclusion: Spinal fusion may lead to a better clinical outcome than decompression alone. No conclusion about the clinical benefit of instrumenting a spinal fusion could be made. However, there is moderate evidence that the use of instrumentation improves the chance of achieving solid fusion.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Clinical Trials as Topic / standards
  • Clinical Trials as Topic / statistics & numerical data
  • Decompression, Surgical / statistics & numerical data*
  • Decompression, Surgical / trends
  • Humans
  • Internal Fixators / statistics & numerical data*
  • Internal Fixators / trends
  • Lumbar Vertebrae / pathology
  • Lumbar Vertebrae / physiopathology
  • Lumbar Vertebrae / surgery*
  • Postoperative Complications / etiology
  • Postoperative Complications / physiopathology
  • Postoperative Complications / prevention & control
  • Reoperation / statistics & numerical data
  • Reoperation / trends
  • Spinal Canal / pathology
  • Spinal Canal / physiopathology
  • Spinal Canal / surgery
  • Spinal Cord Compression / etiology
  • Spinal Cord Compression / physiopathology
  • Spinal Cord Compression / prevention & control
  • Spinal Fusion / instrumentation
  • Spinal Fusion / statistics & numerical data*
  • Spinal Fusion / trends
  • Spondylolisthesis / pathology
  • Spondylolisthesis / physiopathology
  • Spondylolisthesis / surgery*
  • Treatment Outcome