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

Dongfan Wang; Wei Wang; Di Han; Sathish Muthu; Juan P Cabrera; Waeel Hamouda; Luca Ambrosio; Jason P Y Cheung; Hai V Le; Gianluca Vadalà; Zorica Buser; Jeffrey C Wang; Samuel Cho; S Tim Yoon; Shibao Lu; Xiaolong Chen; Ashish D Diwan; AO Spine Knowledge Forum Degenerative

doi:10.1007/s00586-023-08041-4

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 Dec 3. doi: 10.1007/s00586-023-08041-4. Online ahead of print.

Authors

Dongfan Wang^{1

2}, Wei Wang^{1

2}, Di Han^{1

2}, Sathish Muthu^{3

4

5}, Juan P Cabrera^{6

7}, Waeel Hamouda^{8

9}, Luca Ambrosio^{10

11}, Jason P Y Cheung¹², Hai V Le¹³, Gianluca Vadalà^{10

11}, Zorica Buser¹⁴, Jeffrey C Wang¹⁵, Samuel Cho¹⁶, S Tim Yoon¹⁷, Shibao Lu^{18

19

20}, Xiaolong Chen^{21

22

23}, Ashish D Diwan^{24

25}; AO Spine Knowledge Forum Degenerative

Affiliations

¹ Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.
² National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China.
³ Orthopaedic Research Group, Coimbatore, Tamil Nadu, India.
⁴ Department of Orthopaedics, Government Medical College, Karur, Tamil Nadu, India.
⁵ Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, Tamil Nadu, India.
⁶ Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile.
⁷ Faculty of Medicine, University of Concepción, Concepción, Chile.
⁸ Department of Neurosurgery, Kasr Alainy Faculty of Medicine, Research and Teaching Hospitals, Cairo University, Cairo, Egypt.
⁹ Neurological & Spinal Surgery Service, Security Forces Hospital, Dammam, Saudi Arabia.
¹⁰ Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
¹¹ Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
¹² Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China.
¹³ Department of Orthopaedic Surgery, University of California, Davis, CA, USA.
¹⁴ Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA.
¹⁵ Department of Orthopaedic Surgery and Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁶ Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁷ Department of Orthopaedics, Emory University, Atlanta, GA, USA.
¹⁸ Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China. spinelu@163.com.
¹⁹ National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China. spinelu@163.com.
²⁰ Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Beijing, 100053, China. spinelu@163.com.
²¹ Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China. chensmalldragon@163.com.
²² National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China. chensmalldragon@163.com.
²³ Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Beijing, 100053, China. chensmalldragon@163.com.
²⁴ Spine Service, Department of Orthopaedic Surgery, St. George Hospital Campus, Sydney, NSW, Australia. a.diwan@spine-service.org.
²⁵ St. George & Sutherland Clinical School, University of New South Wales, Level 3, WR Pitney Building, Kogarah, Sydney, NSW, 2217, Australia. a.diwan@spine-service.org.

PMID: 38043128
DOI: 10.1007/s00586-023-08041-4

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.

Keywords: Degenerative spondylolisthesis; In situ fusion; Lumbar spine; Meta-analysis; Reduction and fusion; Review.

Publication types

Review

Abstract

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