Reduction versus In Situ Fusion for Adult High-Grade Spondylolisthesis: A Systematic Review and Meta-Analysis.
Adult
Blood Loss, Surgical
Bone Screws
Decompression, Surgical
/ methods
Dura Mater
/ injuries
Humans
Neurosurgical Procedures
/ methods
Postoperative Complications
/ epidemiology
Pseudarthrosis
/ epidemiology
Severity of Illness Index
Spinal Fusion
/ methods
Spondylolisthesis
/ surgery
Treatment Outcome
Adult
High-grade spondylolisthesis
In situ fusion
Meta-analysis
Reduction
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
03
02
2020
revised:
03
03
2020
accepted:
04
03
2020
pubmed:
18
3
2020
medline:
22
8
2020
entrez:
18
3
2020
Statut:
ppublish
Résumé
Surgical management of high-grade spondylolisthesis is controversial. Both reduction and in situ fusion are available options, but it remains unclear which approach provides better outcomes. We conducted a systematic review and meta-analysis of studies reporting outcomes following reduction or in situ fusion for adult high-grade spondylolisthesis. PubMed, Embase, Web of Science, and Cochrane databases were last searched on June 24, 2019. We identified 1236 studies after excluding duplicates. After screening, 15 studies were included in the meta-analysis. Random-effects models were used to pool effect estimates. A total of 188 patients were analyzed. Compared with reduction, in situ fusion had a higher mean estimated blood loss (584 mL vs. 451 mL) and a clinically higher incidence of neurologic (48% vs. 15%), pseudarthrosis (13% vs. 8%), and infectious (20% vs. 10%) complications; however, these differences were not statistically significant. Reduction was associated with a clinically higher incidence of overall complications (32% vs. 25%) and dural tears (22% vs. 7%). Reduction provided better pain relief (mean difference [MD] = 5.24 vs. 4.77) and greater change in pelvic tilt (MD = 5.33 vs. 2.60); however, these differences were not statistically significant. Patients who underwent reduction had significantly greater decline in Oswestry Disability Index scores (MD = 55.7 vs. 11.5; P In management of adult high-grade spondylolisthesis, both approaches appeared to be safe and effective. Reduction appeared to offer better disability relief and spinopelvic parameter correction than in situ fusion.
Sections du résumé
BACKGROUND
Surgical management of high-grade spondylolisthesis is controversial. Both reduction and in situ fusion are available options, but it remains unclear which approach provides better outcomes. We conducted a systematic review and meta-analysis of studies reporting outcomes following reduction or in situ fusion for adult high-grade spondylolisthesis.
METHODS
PubMed, Embase, Web of Science, and Cochrane databases were last searched on June 24, 2019. We identified 1236 studies after excluding duplicates. After screening, 15 studies were included in the meta-analysis. Random-effects models were used to pool effect estimates.
RESULTS
A total of 188 patients were analyzed. Compared with reduction, in situ fusion had a higher mean estimated blood loss (584 mL vs. 451 mL) and a clinically higher incidence of neurologic (48% vs. 15%), pseudarthrosis (13% vs. 8%), and infectious (20% vs. 10%) complications; however, these differences were not statistically significant. Reduction was associated with a clinically higher incidence of overall complications (32% vs. 25%) and dural tears (22% vs. 7%). Reduction provided better pain relief (mean difference [MD] = 5.24 vs. 4.77) and greater change in pelvic tilt (MD = 5.33 vs. 2.60); however, these differences were not statistically significant. Patients who underwent reduction had significantly greater decline in Oswestry Disability Index scores (MD = 55.7 vs. 11.5; P
CONCLUSIONS
In management of adult high-grade spondylolisthesis, both approaches appeared to be safe and effective. Reduction appeared to offer better disability relief and spinopelvic parameter correction than in situ fusion.
Identifiants
pubmed: 32179186
pii: S1878-8750(20)30498-8
doi: 10.1016/j.wneu.2020.03.030
pii:
doi:
Types de publication
Comparative Study
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
512-520.e2Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.