A meta-analysis of the clinical outcomes of arthrodesis in situ or after reduction for low-grade lumbar isthmic spondylolisthesis

CHEN Jia-hai; BAI Xue-dong; LIU Li-yang; WANG Jing; LIN Ling-han; WANG De-li; HE Qing; RUAN Di-ke

doi:10.3969/j.issn.2095-252X.2017.05.012

Abstract：Objective To systematically evaluate the clinical outcomes of arthrodesis in situ or after reduction for low-grade ( Ⅰ and Ⅱ ) lumbar isthmic spondylolisthesis. Methods A comprehensive search of both randomized clinical trials ( RCTs ) and cohort studies on arthrodesis in situ or after reduction for low-grade lumbar isthmic spondylolisthesis published up to April 2016 was performed in PubMed, Cochrane Library, Embase, Sinomed, China Knowledge Resource Integrated Database ( CNKI ), Wanfang Data and Vip Datebase. For the RCTs, we used the Jarad scale to assess the methodological quality, and for the cohort studies, the Newcastle-Ottawa scale ( NOS ) seemed more suitable. Two of the authors ( CHEN Jia-hai, BAI Xue-dong ) independently extracted the articles and predefined data. Statistical analyses were performed using Review Manager 5.3 software. Results Two RCTs and 2 cohort studies were included in this meta-analysis after systematic retrieval and screening. The patients who underwent reduction did achieve better slippage correction when compared with arthrodesis in situ [ SMD = -1.58, 95% CI ( -2.09 - -1.06 ), P < 0.00001 ] and the slippage correction was preserved after more than 2 years' follow-up [ MD = 20.05, 95% CI( 17.71 - 22.38 ), P < 0.00001 ]. However, there was no significant difference in the Oswestry disability index ( ODI ) [ MD = 1.136, 95% CI ( -1.34 - 3.60 ), P = 0.37 ], visual analogue scale ( VAS ) [ MD = 0.06, 95% CI ( -0.21 - 0.32 ), P = 0.67 ], excellent and good rate [ RR = 1.01, 95% CI ( 0.92 - 1.10 ), P = 0.87 ], fusion rate [ RR = 0.99, 95% CI ( 0.93 - 1.06 ), P = 0.81 ] and complication rate [ RR = 0.78, 95% CI ( 0.36 - 1.72 ), P = 0.54 ] between the arthrodesis in situ group and the reduction group. Conclusions Arthrodesis after reduction for low-grade lumbar isthmic spondylolisthesis reduces vertebral slippage well and preserves the reduction effectively, but it makes no difference in the clinical outcomes of the 2 surgical treatment methods. Both methods can relieve low back pain, achieve a good fusion rate and improve patients' satisfaction. How to choose the surgical method depends on the patient's condition and the orthopedist's surgical experience. A further study is needed on the long-term clinical outcomes and spinal sagittal balance.