Management for degenerative lumbar spondylolisthesis: a network meta-analysis and systematic review basing on randomized controlled trials

Abstract

Background: Consensus on the various interventions for degenerative lumbar spondylolisthesis (DLS) remains unclear. Materials and methods: We searched PubMed, Embase, Cochrane Library, Web of Science, and major scientific websites until Nov 01, 2023, to screen eligible randomized controlled trials (RCTs) involving the treatment of DLS. The seven most common DLS interventions (non-surgical [NS], decompression only [DO], decompression plus fusion without internal fixation [DF], decompression plus fusion with internal fixation [DFI], endoscopic decompression plus fusion [EDF], endoscopic decompression [ED], and circumferential fusion [360F]) were compared. The primary (pain and disability) and secondary (complications, reoperation rate, operation time, blood loss, length of hospital stay, and satisfaction) outcomes were analyzed. Results: Data involving 3,273 patients in 16 RCTs comparing the efficacy of different interventions for DLS were reported. In terms of improving patient pain and dysfunction, there was a significant difference between surgical and NS. EDF showed the greatest improvement in short-term and long-term dysfunction (probability, 7.1% and 21.0%). Moreover, EDF had a higher complication rate (probability 70.8%), lower reoperation rate (probability, 20.2%), and caused greater blood loss (probability, 82.5%) than other surgical interventions. Endoscopic surgery had the shortest hospitalization time (EDF: probability, 42.6%; ED: probability, 3.9%). DF and DFI had the highest satisfaction scores. Conclusions: Despite the high complication rate of EDF, its advantages include improvement in pain, lower reoperation rate, and shorter hospitalization duration. Therefore, EDF may be a good option for patients with DLS as a less invasive surgical approach.