ReviewWhich is the optimum surgical strategy for spondylolisthesis: Reduction or fusion in situ? A meta-analysis from 12 comparative studies

- We had got more studies compared to the former “meta-analysis” or “system review” which we had searched.
- We tightened the eligible criteria compared to the former “meta-analysis” or “system review”.
- Subgroup analysis between “high grade” and “low grade” will make readers realize the outcomes clearly and directly.

PurposeTo compare the clinical outcomes and complications and radiographic outcomes of the two different surgical strategies (arthrodesis in situ and arthrodesis following reduction) for the surgical management of spondylolisthesis.MethodsAfter systematic search the PubMed, Ovid MEDLINE, Cochrane, and Embase databases, comparative studies were selected according to eligibility criteria. Checklists by Furlan and by The Newcastle-Ottawa quality assessment scale (NOS scale) were used to evaluate the risk of bias of the included randomized clinical trials (RCTs) and nonrandomized controlled studies, respectively. The final strength of evidence was expressed as different levels recommended by the GRADE Working Group.ResultsThree RCTs. and nine comparative observational studies were identified. Low-quality evidence indicated that reduction group (RG) was not more effective than fusion in situ group for clinical satisfaction (OR 0.77, 95% CI 0.39-1.54, P = 0.46). and neurologic complication rate (OR 0.89, 95 CI 0.38-2.03, P = 0.78). In secondary outcomes, Low-quality evidence indicated that RG improved fusion rate (OR 2.66, 95% CI 1.15-6.14, P = 0.02). There was no significant difference in the other complication rate (OR 0.89, 95% CI 0.44-1.79, P = 0.63) and blood loss (WMD 14.22, 95% CI -9.53-37.79, P = 0.24) between two groups. Statistical difference was found between the two groups with regard to slipping angle (WMD -6.33, 95% CI -12.60 to -0.06, P = 0.05).ConclusionsThere was no definite benefit of reduction over fusion in situ in clinical satisfaction rate and neurologic complication rate. The fusion rate significantly improved while the slipping angle considerably decreased postoperation in reduction group.