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Clinical effectiveness of reduction and fusion versus in situ fusion in the management of degenerative lumbar spondylolisthesis: a systematic review and meta-analysis

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Abstract

Purpose

To compare the clinical effectiveness of reduction and fusion with in situ fusion in the management of patients with degenerative lumbar spondylolisthesis (DLS).

Methods

The systematic review was conducted following the PRISMA guidelines. Relevant studies were identified from PubMed, Embase, Scopus, Cochrane Library, ClinicalTrials.gov, and Google Scholar. The inclusion criteria were: (1) comparative studies of reduction and fusion versus in situ fusion for DLS patients, (2) outcomes reported as VAS/NRS, ODI, JOA score, operating time, blood loss, complication rate, fusion rate, or reoperation rate, (3) randomized controlled trials and observational studies published in English from the inception of the databases to January 2023. The exclusion criteria included: (1) reviews, case series, case reports, letters, and conference reports, (2) in vitro biomechanical studies and computational modeling studies, (3) no report on study outcomes. The risk of bias 2 (RoB2) tool and the Newcastle–Ottawa scale was conducted to assess the risk of bias of RCTs and observational studies, respectively.

Results

Five studies with a total of 704 patients were included (375 reduction and fusion, 329 in situ fusion). Operating time was significantly longer in the reduction and fusion group compared to in situ fusion group (weighted mean difference 7.20; 95% confidence interval 0.19, 14.21; P = 0.04). No additional significant intergroup differences were noted in terms of other outcomes analyzed.

Conclusion

While the reduction and fusion group demonstrated a statistically longer operating time compared to the in situ fusion group, the clinical significance of this difference was minimal. The findings suggest no substantial superiority of lumbar fusion with reduction over without reduction for the management of DLS.

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Acknowledgements

This study was organized by AO Spine through the AO Spine Knowledge Forum Degenerative, a focused group of international spine degeneration experts. AO Spine is a clinical division of the AO Foundation, which is an independent medically-guided not-for-profit organization. Study support was provided directly through the AO Spine Research Department.

Funding

This study was funded by Beijing Hospitals Authority Ascent Plan (DFL20190802) and Beijing Hospitals Authority Clinical Medicine Development of special funding support (XMLX202116).

Author information

Authors and Affiliations

  1. Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China

    Dongfan Wang, Wei Wang, Di Han, Shibao Lu & Xiaolong Chen

  2. National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China

    Dongfan Wang, Wei Wang, Di Han, Shibao Lu & Xiaolong Chen

  3. Orthopaedic Research Group, Coimbatore, Tamil Nadu, India

    Sathish Muthu

  4. Department of Orthopaedics, Government Medical College, Karur, Tamil Nadu, India

    Sathish Muthu

  5. Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, Tamil Nadu, India

    Sathish Muthu

  6. Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile

    Juan P. Cabrera

  7. Faculty of Medicine, University of Concepción, Concepción, Chile

    Juan P. Cabrera

  8. Department of Neurosurgery, Kasr Alainy Faculty of Medicine, Research and Teaching Hospitals, Cairo University, Cairo, Egypt

    Waeel Hamouda

  9. Neurological & Spinal Surgery Service, Security Forces Hospital, Dammam, Saudi Arabia

    Waeel Hamouda

  10. Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy

    Luca Ambrosio & Gianluca Vadalà

  11. Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy

    Luca Ambrosio & Gianluca Vadalà

  12. Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China

    Jason P. Y. Cheung

  13. Department of Orthopaedic Surgery, University of California, Davis, CA, USA

    Hai V. Le

  14. Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA

    Zorica Buser

  15. Department of Orthopaedic Surgery and Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Jeffrey C. Wang

  16. Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Samuel Cho

  17. Department of Orthopaedics, Emory University, Atlanta, GA, USA

    S. Tim Yoon

  18. Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Beijing, 100053, China

    Shibao Lu & Xiaolong Chen

  19. Spine Service, Department of Orthopaedic Surgery, St. George Hospital Campus, Sydney, NSW, Australia

    Ashish D. Diwan

  20. St. George & Sutherland Clinical School, University of New South Wales, Level 3, WR Pitney Building, Kogarah, Sydney, NSW, 2217, Australia

    Ashish D. Diwan

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  1. Dongfan Wang
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Correspondence to Shibao Lu, Xiaolong Chen or Ashish D. Diwan.

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Wang, D., Wang, W., Han, D. et al. Clinical effectiveness of reduction and fusion versus in situ fusion in the management of degenerative lumbar spondylolisthesis: a systematic review and meta-analysis. Eur Spine J (2023). https://doi.org/10.1007/s00586-023-08041-4

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