Abstract
Purpose
This systematic review summarises the literature on patient selection, decision-making, effectiveness and outcomes in the surgical treatment of lumbar degenerative spondylolisthesis (LDS).
Introduction
In daily practice, decision-making in the treatment of LDS is challenging. There is little consensus on either the precise indications or prognostic factors for any specific therapy (operative or non-operative).
Methods
We searched for LDS trials published between 01.01.1990 and 16.11.2011 in Medline, Embase, Cochrane Library and Cinahl. Two independent reviewers selected studies according to the inclusion criteria. Data were then extracted by two of the authors. Quality assessment was performed using the Downs and Black list for the clinical trials/studies and AMSTAR for the reviews.
Results
Data synthesis: 21 papers met the inclusion criteria (2 studies comprising both a RCT and a concurrent observational analysis, 1 RCT, 6 prospective studies, 8 retrospective studies, 3 reviews, 1 review guideline). The quality of the clinical studies was on average “fair” [mean score 15.6 points (range 10–19) out of 24 points (Downs and Black)]. The quality of the reviews ranged from 1 to 7 out of 11 points with an average of 5 points (AMSTAR). The study outcomes could not be subject to meta-analysis due to heterogeneity of study design and variable measure used.
Conclusions
Despite there being many articles describing and/or comparing different surgical options for LDS, there was insufficient evidence to draw conclusions concerning clear indications for specific types of surgical treatment, predictors of outcome or complication rates. There remains a need to establish a decision-making tool to facilitate daily clinical practice and to assure appropriate treatment for patients with LDS.
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Acknowledgments
SNF Swiss National Science Foundation (grant number IZ32Z0_141535): Wildhainweg 3, 3001 Bern. Eurospine, the Spine Society of Europe: Seefeldstrasse 16, 8610 Uster, (Administrative Office). Schulthess Klinik Research Funds: Lengghalde 8, 8008 Zürich.
Conflict of interest
There is no conflict of interest. The authors have no financial or personal relationships that might potentially influence their reporting or interpretation of studies.
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F. Steiger and H.-J. Becker contributed equally to this work.
Appendices
Appendix 1: Search strategy and results
Appendix 2
See Table 5.
Appendix 3: Excluded studies after full text consultation
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Steiger, F., Becker, HJ., Standaert, C.J. et al. Surgery in lumbar degenerative spondylolisthesis: indications, outcomes and complications. A systematic review. Eur Spine J 23, 945–973 (2014). https://doi.org/10.1007/s00586-013-3144-3
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DOI: https://doi.org/10.1007/s00586-013-3144-3