Meta-analysis of posterolateral fusion and posterior lumbar interbody fusion in the treatment of lumbar spondylolisthesis

LIU Xiao-yang; WANG Yi-peng; YU Bin

doi:10.3969/j.issn.2095-252X.2013.10.004

Abstract：Objective To systematically review the clinical results of posterolateral fusion ( PLF ) and posterior lumbar interbody fusion ( PLIF ) for lumbar spondylolisthesis, and to collect better scientific evidence in the treatment of lumbar spondylolisthesis. Methods The computer retrieval of Medline, Embase and Cochrane Central Register of Controlled Trials ( CENTRAL ) was performed, and related journals were manually searched. The randomized controlled trials ( RCTs ) and comparative studies were performed to analyze the clinical results of PLF and PLIF in the treatment of lumbar spondylolisthesis. The methodological quality included in the RCT was evaluated according to the Furlan standard, and the methodological quality of observational studies was evaluated by the Cowley standard. The meta-analysis of all the data was carried out using the RevMan5.0 software. The levels of evidence of the clinical results were evaluated by the Grades of Recommendation, Assessment, Development, and Evaluation ( GRADE ) Working Group. Results Through systematic retrieval and screening, 4 RCTs and 5 pieces of observational studies were identiifed, with 520 patients in all. The analysis results showed that patients were more satisifed after PLIF 86.7%than those after PLF 76.6%( OR:0.49, 95%CI:0.28, 0.88, P=0.02 ), and no signiifcant differences were found in the complication rate ( OR:2.28, 95%CI:0.97, 5.35, P=0.06 ). In addition, the fusion rate of PLIF 92.5%was higher than that of PLF 79.6%( OR:0.32, 95%CI:0.17, 0.61, P=0.0006 ), and the reoperation rate of PLIF 3.6%was lower than that of PLF 17.3%( OR:5.30, 95%CI:1.47, 19.11, P=0.01 ). No statistically signiifcant differences were found between the 2 groups with regard to the blood loss ( Weighted Mean Difference WMD=76.52, 95%CI:-310.68, 463.73, P=0.70 ) and operation time ( WMD=-1.20, 95%CI:-40.36, 37.97, P=0.95 ). Conclusions PLIF can better improve patient satisfaction, relieve postoperative pain, increase the fusion rate and reduce the reoperation rate when compared with PLF. No differences are found between the 2 fusion methods in terms of improvement in the functional status, complication rate, operation time and blood loss in the treatment of lumbar spondylolisthesis.