The Surgical Management of Low Grade Single Level Adult Degenerative Spondylolisthesis: Posterolateral Fusion versus Posterior Lumbar Interbody Fusion

Abed, Khaldoun El

doi:10.15406/mojor.2014.01.00001

Cited by 1 publication

(1 citation statement)

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“…The posterior approach group shows deterioration of the correction with time on follow-up radiographs, accounting for the increased symptoms. 21,22 Suk et al 6 found that ALIF is better in the prevention of reduction loss. The repair of the slip angle leads to apposition of the central body axis over the sacrum, which leads to decreased tension on the graft.…”

Section: Questionsmentioning

confidence: 99%

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

et al. 2019

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Background: Lumbar isthmic spondylolisthesis (IS) in adults is defined as the forward slippage of a vertebra onto the top of the vertebra, resulting from a defect in the pars intraarticular, and can be low grade or high grade. Persistent back pain or neurological deficit are indications for surgical intervention. Surgery can be done from back, front, or both, with or without fusion, instrumentation, or decompression, and short or long segment. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, several databases were searched through August 2017 for any observational or experimental studies that evaluated combined anterior-posterior approach versus posterior alone in management of IS. Primary outcome was fusion rate, whereas secondary outcomes included functional outcomes (Visual Analogue Scale [VAS] and Oswestry Disability Index [ODI] score), complication rate (infection, neurological), and reoperation rate. Descriptive, quantitative, and qualitative data were extracted. Most of the cases were low-grade IS. Results: Of the 645 articles identified, 6 studies were eligible for the meta-analysis, with a total of 397 patients with IS, 198 in the combined (anterior interbody fusion [ALIF] þ postero-lateral fusion [PLF]) group and 199 in the posterior (transformational interbody fusion [TLIF]/ postero-lateral interbody fusion [PLIF] þ PLF) group, average age of 47.2 years, and 185:212 male : female ratio. Although the fusion rate reached 100% in some studies, the pooled odds ratio (OR) of fusion rate (OR ¼ 1.02, 95% confidence interval [CI]: 0.294, 3.552, P ¼ .972) did not reach statistical significance between (ALIF þ PLF) versus (TLIF/PLIF þ PLF). The estimated pooled standardized mean difference (SMD) showed less blood loss in the anterior approach compared to the posterior approach (SMD ¼À0.528, 95% CI: À0.777, À0.278, P , .001), with no difference in operative time and length of hospital stay. Despite both groups showing significant improvement in pain and functional scores at final follow up, ODI and VAS were not significantly different between groups with ODI (SMD ¼À0.644, 95% CI: À1.948, 0.621, P ¼ .311) and VAS (SMD ¼ 0.113, 95% CI: À0.173, 0.400, P ¼ .439). The complication rate for the anterior approach was higher than the posterior, whereas reoperation rate was higher in the posterior approach than the anterior. Conclusions: No significant difference between anterior and posterior approaches was found in the global assessment of fusion rate and clinical outcomes, despite a higher rate of complications using the anterior approach. Level of Evidence: 3. Clinical Relevance: Both anterior and posterior approach are a valid option for treatment of isthemic spondylolisthesis Lumbar Spine

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Section: Questionsmentioning

confidence: 99%