Functional and Radiological Outcomes of Combined Anterior-Posterior Approach Versus Posterior Alone in Management of Isthmic Spondylolisthesis. A Systematic Review and Meta-Analysis

Alhammoud, Abduljabbar; Schroeder, Gregory D.; Aldahamsheh, Osama; Alkhalili, Kenan; Lendner, Mayan; Moghamis, Isam Sami; Vaccaro, Alexander R.

doi:10.14444/6031

Cited by 25 publications

(29 citation statements)

References 22 publications

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“…Our satisfactory outcome rate (91%), fusion rate (100%), and complication rate (9%) were similar to those of studies in which low-grade spondylolisthesis was treated with ALIF alone or ALIF with posterior instrumentation. In our study, the fusion rate (100%) is relative high among the similar studies [ 10 – 13 , 41 ]. The reason may be that all of our cases undergone posterior instrumentation.…”

Section: Discussionsupporting

confidence: 54%

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Direct reduction of high-grade lumbosacral spondylolisthesis with anterior cantilever technique - surgical technique note and preliminary results

Shih

Chen

et al. 2021

BMC Musculoskelet Disord

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Backgrounds Surgical reduction for high-grade spondylolisthesis is beneficial for restoring sagittal balance and improving the biomechanical environment for arthrodesis. Compared to posterior total laminectomy and long instrumentation, anterior lumbar inter-body fusion (ALIF) is less invasive and has the biomechanical advantage of restoring the original disk height and increasing lumbar lordosis, thus improving sagittal balance. However, the application of ALIF is still limited in treating low-grade spondylolisthesis. In this study, we developed a new technique termed anterior cantilever procedure to directly reduce the slippage of high-grade lumbosacral spondylolisthesis. The purpose of our study was to investigate the surgical outcomes of the anterior cantilever procedure followed by ALIF and posterior mono-segment instrumented fixation in high-grade spondylolisthesis. Methods All patients with high-grade spondylolisthesis who underwent anterior cantilever procedure followed by anterior lumbar inter-body fusion (ALIF) and posterior mono-segment instrumented fixation between November 2006 and July 2017 were enrolled in our study. The slip percentage, Dubousset’s lumbosacral angle, pelvic tilt, sacral slope, pelvic incidence, and sagittal alignment were measured pre-operatively and postoperatively at the last follow-up. Surgery time, blood loss, complications, and hospital stay were also collected and analysed. Results A total of 11 consecutive patients with high-grade spondylolisthesis patients were included and analysed. All of the high-grade spondylolisthesis in our series occurred at the L5-S1 level. The median age was 37 years, and the median follow-up duration was 36 months. The average slip reduction was 30% (60 to 30%, P < 0.01), and the average correction of Dubousset’s lumbosacral angle was 13.8° (84.1° to 97.9°, P < 0.01). The median intra-operative blood loss was 300 mL. All patients attained improved sagittal balance after the operation and achieved solid fusion within 9 months after surgery. No incidences of implant failure, permanent neurological deficit, or pseudarthrosis were recorded at the last follow-up. Conclusions Anterior cantilever procedure followed by ALIF and posterior mono-segment instrumented fixation is a valid procedure for treating high-grade spondylolisthesis. It achieved a high fusion rate, partially reduced slippage, and significantly improved lumbosacral angle, while minimizing common complications, such as pseudarthrosis, nerve traction injury, excessive soft tissue dissection, and blood loss in posterior reduction procedures. However, posterior instrumentation is still required to the structural stability in the ALIF procedure. Level of evidence IV

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Section: Discussionsupporting

confidence: 54%

“…In order to attain the abovementioned advantages, some authors advocated ALIF and percutaneous pedicle screws to treat isthmic spondylolisthesis [ 10 – 12 ]. Though good to excellent results have been reported, to date, the application of ALIF is still limited in the treatment of low-grade lumbar spondylolisthesis [ 11 – 13 ].…”

Section: Backgroundsmentioning

confidence: 99%

Direct reduction of high-grade lumbosacral spondylolisthesis with anterior cantilever technique - surgical technique note and preliminary results

Shih

Chen

et al. 2021

BMC Musculoskelet Disord

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“…Various studies have reported that the surgical treatment of isthmic spondylolisthesis significantly improves functional outcomes 1,7,16) . Through many years of follow-up on surgically treated spondylolytic patients, numerous studies described the surgical results and degeneration of adjacent segments to fused vertebrae 2,23,29) .…”

Section: )mentioning

confidence: 99%

Fate of Untreated Adjacent Spondylolysis in Selectively Surgically Treated Patients with Multi-Level Spondylolysis: Should All Segments Always be Fused?

Park

Kim

Kang

et al. 2020

Nerve

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The purpose of this study was to observe the natural course of remained untreated spondylolysis adjacent to previous fusion segments in patients with multi-level lysis and its clinical outcome. Methods: Nineteen patients who underwent selective fusion of multi-level spondylolysis (MLS) at a single institute were enrolled. As a matched cohort for comparison, 19 patients who had single-level spondylolysis (SLS) and undergone singlelevel fusion with similar demographics and preoperative radiologic measurements as the MLS group were included. We evaluated the preoperative, postoperative, and last followup angular displacement and sagittal translation on dynamogram radiographs, and axial and radial pain using the visual analogue scale in both groups. We then compared the increment in radiological instability and clinical outcome between the MLS and SLS groups. Results: There were no significant differences in patient demographics and preoperative radiological measurements, including disc degeneration, facet degeneration, lumbar lordosis, pelvic incidence, and sacral table angle between both groups. Both groups showed an increase in the average angular displacement and slippage during the final follow-up as compared to preoperative findings, but no significant difference was noticed between them. Both the MLS and SLS groups showed improvement in lower back pain and leg pain from before surgery, but with no statistical significance. Conclusion: Selective fusion in patients with multiple spondylolysis can be an alternative surgical option without increasing the risk of adjacent segment degeneration under strict narrow indications. However, a thorough preoperative evaluation is needed to prevent early surgical failure.

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“…Nonoperative management tends to be considered for minimally symptomatic or asymptomatic adolescents with low-grade spondylolisthesis (12). At the same time, surgical treatment provides a better outcome for those who are unresponsive to conservative therapy, such as individuals with high-grade spondylolisthesis, continual symptomatology, or neurological deficits (13)(14)(15)(16). In terms of surgical management, arthrodesis has shown to be effective for lumbar spondylolisthesis (17), but consensus has yet to be reached on whether reduction or arthrodesis in situ is the more suitable technique for adolescent spondylolisthesis.…”

Section: Introductionmentioning

confidence: 99%

Is reduction or arthrodesis in situ the optimal choice for adolescent spondylolisthesis?—a systematic review and meta- analysis

Zhan¹,

Xi²,

Li³

et al. 2021

Ann Palliat Med

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Background: Controversy remains about the choice of reduction or arthrodesis in situ for surgical management of adolescent spondylolisthesis, while no systematic review and meta-analysis were performed to determine which one is the optimal surgical choice. The study aims to compare outcomes of the two surgical strategies for adolescent spondylolisthesis. Methods: A comprehensive search was performed through PubMed, Web of Science, Cochrane Library, Embase, OVID/MEDLINE, CBM, CNKI, and Wanfang with a cutoff date of May 21 st , 2021. Search terms included "spondylolisthesis", "in situ" and "reduction". Included studies had following characteristics: (I) participants: adolescents with spondylolisthesis. (II) Intervention: reduction following arthrodesis. (III) Control: arthrodesis in situ. (IV) Outcomes: postoperative clinical and/or radiographic results. (V) Study design: randomized controlled trial (RCT), cohort or case-control study. Data were analyzed with Review Manager 5.4, and risk of bias assessment of studies was assessed via Newcastle-Ottawa quality assessment scale (NOS).Results: Six cohort studies were included, with NOS scores of all ≥6. There were no significant differences regarding operative time [mean difference (MD) =152.62; 95% [confidence interval (CI)]: −54.02 to 359.26; I 2 =96%; P=0.15], blood loss (MD =786.61; 95% CI: −646.82 to 2,220.04; I 2 =90%; P=0.28), patient satisfaction (MD =1.98; 95% CI: 0.72 to 5.43; I 2 =0%; P=0.18), neurological complications (MD =1.02; 95% CI: 0.25 to 4.18; I 2 =0%; P=0.98), or total complications (MD =0.59; 95% CI: 0.29 to 1.19; I 2 =0%; P=0.14). However, patients undergoing reduction achieved better radiographic results: fusion rate (MD =3.09; 95% CI: 1.22 to 7.84;I 2 =40%; P=0.02), postoperative pseudarthrosis (MD =0.35; 95% CI: 0.15 to 0.79; I 2 =24%; P=0.01), percentage of slippage (MD =−20.58; 95% CI: −26.32 to −14.84; I 2 =0%; P<0.00001), and slipping angle (MD =−10.05; 95% CI: −14.55 to −5.54; I 2 =0%; P<0.0001). And no overt publication bias was found in the studies.Discussion: Both reduction and arthrodesis in situ in adolescent spondylolisthesis are safe and demonstrate good clinical outcomes. However, reduction showed better radiographic results and was associated with less pseudarthrosis, better relief of disability, and improvements in self-image. In conclusion, reduction may be the optimal choice compared with arthrodesis in situ, but further verification of these findings is recommended using RCTs.

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Functional and Radiological Outcomes of Combined Anterior-Posterior Approach Versus Posterior Alone in Management of Isthmic Spondylolisthesis. A Systematic Review and Meta-Analysis

Cited by 25 publications

References 22 publications

Direct reduction of high-grade lumbosacral spondylolisthesis with anterior cantilever technique - surgical technique note and preliminary results

Direct reduction of high-grade lumbosacral spondylolisthesis with anterior cantilever technique - surgical technique note and preliminary results

Fate of Untreated Adjacent Spondylolysis in Selectively Surgically Treated Patients with Multi-Level Spondylolysis: Should All Segments Always be Fused?

Is reduction or arthrodesis in situ the optimal choice for adolescent spondylolisthesis?—a systematic review and meta- analysis

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