Skip to main content

Advertisement

SpringerLink
Log in

The comparison of instrumented and non-instrumented fusion in the treatment of lumbar spondylolisthesis: a meta-analysis

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

This meta-analysis compared whether fusion with or without instrumentation to treat this disease differed with respect to patient-centered outcomes.

Methods

Medline, Cochrane, EMBASE, Google Scholar data bases were searched for randomized control trials that investigated patients with severe chronic lower back pain resulting from localized lumbar or lumbosacral instability caused by either isthmic spondylolisthesis or degenerative spondylolisthesis. Included randomized studies reported quantitative outcomes for low back pain and functional recovery. The primary outcome was the improvement of function and the secondary outcomes were the improvement of pain, patients’ satisfactory level, and the fusion rate.

Results

A significantly lower function change in patients with instrumented compared with non-instrumented from baseline (pooled standardized mean difference; −1.02 (95 % CI −1.76 to −0.27); Z −2.67; (P = 0.008)]. There was no significant pain change for patients with instrumented compared with that of non-instrumented from baseline [pooled standardized mean difference; −0.07 (95 % CI −1.25 to 1.12); Z −0.11; (P = 0.913)]. There was no significant difference in satisfactory level for patients with instrumented compared with that of non-instrumented [pooled OR; 2.36 (95 % CI 0.91–6.11); Z 1.76; (P = 0.078)]. There was significantly higher fusion rate for patients with instrumented compared with that of non-instrumented [pooled OR; 3.28 (95 % CI 2.22–4.85); Z 5.96; (P < 0.001)].

Conclusions

This meta-analysis found that inclusion of fusion surgery with instrumentation provided no benefit as evaluated by patient-reported outcomes in patients with lumbar spondylolisthesis.

Level of evidence

Not applicable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ediriweera ER, Gunathilka HD, Weerasinghe KD, Kalawana OT (2013) Efficacy of traditional treatment regimen of Kati Shoola with special reference to lumbar spondylolisthesis. Ayu 34:86–89

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Bridwell KH, Sedgewick TA, O’Brien MF, Lenke LG, Baldus C (1993) The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord 6:461–472

    Article  CAS  PubMed  Google Scholar 

  3. Cheng L, Nie L, Zhang L (2009) Posterior lumbar interbody fusion versus posterolateral fusion in spondylolisthesis: a prospective controlled study in the Han nationality. Int Orthop 33:1043–1047

    Article  PubMed Central  PubMed  Google Scholar 

  4. Ha KY, Na KH, Shin JH, Kim KW (2008) Comparison of posterolateral fusion with and without additional posterior lumbar interbody fusion for degenerative lumbar spondylolisthesis. J Spinal Disord Tech 21:229–234

    Article  PubMed  Google Scholar 

  5. Crawford NR, Cagli S, Sonntag VK, Dickman CA (2001) Biomechanics of grade in degenerative lumbar spondylolisthesis. Part 1: in vitro model. J Neurosurg 94(1 Suppl):45–50

    CAS  PubMed  Google Scholar 

  6. Dai LY, Jia LS, Yuan W, Ni B, Zhu HB (2001) Direct repair of defect in lumbar spondylolysis and mild isthmic spondylolisthesis by bone grafting, with or without facet joint fusion. Eur Spine J 10:78–83

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Watters WC 3rd, Bono CM, Gilbert TJ, Kreiner DS, Mazanec DJ, Shaffer WO, Baisden J, Easa JE, Fernand R, Ghiselli G, Heggeness MH, Mendel RC, O’Neill C, Reitman CA, Resnick DK, Summers JT, Timmons RB, Toton JF, North American Spine Society (2009) An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. Spine J 9:609–614

    Article  PubMed  Google Scholar 

  8. Bridwell KH, Sedgewick TA, O’Brien MF, Lenke LG, Baldus C (1993) The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord 6:461–472

    Article  CAS  PubMed  Google Scholar 

  9. Kornblum MB, Fischgrund JS, Herkowitz HN, Abraham DA, Berkower DL, Ditkoff JS (2004) Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion and pseudarthrosis. Spine (Phila Pa 1976) 29:726–733 (discussion 733–724)

    Article  Google Scholar 

  10. Gibson JN, Waddell G (2005) Surgery for degenerative lumbar spondylosis. Cochrane Database Syst Rev. doi:10.1002/14651858.CD001352.pub3(4):CD001352

    Google Scholar 

  11. Kimura I, Shingu H, Murata M, Hashiguchi H (2001) Lumbar posterolateral fusion alone or with transpedicular instrumentation in l4–l5 degenerative spondylolisthesis. J Spinal Disord 14:301–310

    Article  CAS  PubMed  Google Scholar 

  12. Martin CR, Gruszczynski AT, Braunsfurth HA, Fallatah SM, O’Neil J, Wai EK (2007) The surgical management of degenerative lumbar spondylolisthesis: a systematic review. Spine (Phila Pa 1976) 32:1791–1798

    Article  Google Scholar 

  13. Han X, Zhu Y, Cui C, Wu Y (2009) A meta-analysis of circumferential fusion versus instrumented posterolateral fusion in the lumbar spine. Spine (Phila Pa 1976) 34:E618–E625

    Article  Google Scholar 

  14. Mardjetko SM, Connolly PJ, Shott S (1994) Degenerative lumbar spondylolisthesis. A meta-analysis of literature 1970–1993. Spine (Phila Pa 1976) 19(20 Suppl):2256S–2265S

    Article  CAS  Google Scholar 

  15. Dantas FL, Prandini MN, Ferreira MA (2007) Comparison between posterior lumbar fusion with pedicle screws and posterior lumbar interbody fusion with pedicle screws in adult spondylolisthesis. Arq Neuropsiquiatr 65:764–770

    Article  PubMed  Google Scholar 

  16. Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurtz LT (1997) 1997 volvo award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine (Phila Pa 1976) 22:2807–2812

  17. Liu X, Wang Y, Qiu G, Weng X, Yu B (2013) A systematic review with meta-analysis of posterior interbody fusion versus posterolateral fusion in lumbar spondylolisthesis. Eur Spine J. doi:10.1007/s00586-013-2880-8

    Google Scholar 

  18. Gibson JN, Grant IC, Waddell G (1999) The cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis. Spine (Phila Pa 1976) 24:1820–1832

    Article  CAS  Google Scholar 

  19. Turner JA, Ersek M, Herron L, Deyo R (1992) Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine (Phila Pa 1976) 17:1–8

    Article  CAS  Google Scholar 

  20. Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, Knipschild PG (1998) The delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by delphi consensus. J Clin Epidemiol 51:1235–1241

    Article  CAS  PubMed  Google Scholar 

  21. Sutton AJ, Duval SJ, Tweedie RL, Abrams KR, Jones DR (2000) Empirical assessment of effect of publication bias on meta-analyses. BMJ 320:1574–1577

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Zdeblick TA (1993) A prospective, randomized study of lumbar fusion. Preliminary results. Spine (Phila Pa 1976) 18:983–991

    Article  CAS  Google Scholar 

  23. Abdu WA, Lurie JD, Spratt KF, Tosteson AN, Zhao W, Tosteson TD, Herkowitz H, Longely M, Boden SD, Emery S, Weinstein JN (2009) Degenerative spondylolisthesis: does fusion method influence outcome? Four-year results of the spine patient outcomes research trial. Spine (Phila Pa 1976) 34:2351–2360

    Article  Google Scholar 

  24. Moller H, Hedlund R (2000) Instrumented and noninstrumented posterolateral fusion in adult spondylolisthesis—a prospective randomized study: Part 2. Spine (Phila Pa 1976) 25:1716–1721

    Article  CAS  Google Scholar 

  25. Forsth P, Michaelsson K, Sanden B (2013) Does fusion improve the outcome after decompressive surgery for lumbar spinal stenosis?: a two year follow-up study involving 5390 patients. Bone Joint J 95-B:960–965

    Article  CAS  PubMed  Google Scholar 

  26. Sigmundsson FG, Jonsson B, Stromgvist B (2014) Preoperative pain pattern predicts surgical outcome more than type of surgery in patients with central spinal stenosis without concomitant spondylolisthesis: a register study of 9051 patients. Spine 39:E199–E210

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou, 350025, China

    Yong-ping Ye & Hao Xu

  2. Fujian Province Command, PLA, Fuzhou, China

    Dang Chen

Authors
  1. Yong-ping Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hao Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yong-ping Ye.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ye, Yp., Chen, D. & Xu, H. The comparison of instrumented and non-instrumented fusion in the treatment of lumbar spondylolisthesis: a meta-analysis. Eur Spine J 23, 1918–1926 (2014). https://doi.org/10.1007/s00586-014-3453-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-014-3453-1

Keywords

Search

Navigation