Fusion in situ versus reduction for spondylolisthesis treatment: grading the evidence through a meta-analysis

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.

Beneficial influence of single-stage posterior surgery for the treatment of lumbar brucella spondylitis combined with spondylolisthesis

“…Therefore, a partial reduction of the spondylolisthesis vertebral body should be recommended. More researchers 27 , 28 suggested reducing the spondylolisthesis vertebral body to the greatest extent, which will help restore the typical spinal sequence and promote bone graft fusion. As the postoperative recovery of brucella spondylitis needs stability, we reduced the spondylolisthesis vertebral body during the operation as much as possible in this study.…”

Spondylolisthesis

“…It is proposed that reduction with anterior and posterior fixation results in improved outcomes and allows for optimal correction of deformity, indirect neuroforaminal decompression, greater surface area for arthrodesis, and increased biomechanical stability. [51][52][53][54][55] With recent recognition of the importance of slip angle and spinopelvic alignment to global sagittal alignment, more evidence suggests that at least partial reduction of slip angle should be considered in the setting of a highgrade slip. Interbody fusion is also favored in these cases to provide greater stability and increase fusion rates.…”

Letter to the editor: "Fusion with and without lever reduction in degenerative lumbar spondylolisthesis—a retrospective study"

“…In a recently published meta-analysis, the authors conducted a comprehensive meta-analysis to compare the outcomes of fusion in situ and reduction in the treatment of lumbar spondylolisthesis [ 2 ].…”