Decompression alone versus decompression with instrumented fusion in the treatment of lumbar degenerative spondylolisthesis: a systematic review and meta-analysis of randomised trials Article Swipe
Radek Kaiser
,
Lucia Kantorová
,
Alena Langaufová
,
Simona Slezáková
,
Dagmar Tučková
,
Miloslav Klugar
,
Zdeněk Klézl
,
Pavel Barša
,
Jan Cienciala
,
Richard Hajdúk
,
Lumír Hrabálek
,
Roman Kučera
,
David Netuka
,
Martin Prýmek
,
Martin Repko
,
Martin Smrčka
,
Jan Štulík
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1136/jnnp-2022-330158
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1136/jnnp-2022-330158
Objective To determine the efficacy of adding instrumented spinal fusion to decompression to treat degenerative spondylolisthesis (DS). Design Systematic review with meta-analysis. Data sources MEDLINE, Embase, Emcare, Cochrane Library, CINAHL, Scopus, ProQuest Dissertations & Theses Global, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform from inception to May 2022. Eligibility criteria for study selection Randomised controlled trials (RCTs) comparing decompression with instrumented fusion to decompression alone in patients with DS. Two reviewers independently screened the studies, assessed the risk of bias and extracted data. We provide the Grading of Recommendations, Assessment, Development and Evaluation assessment of the certainty of evidence (COE). Results We identified 4514 records and included four trials with 523 participants. At a 2-year follow-up, adding fusion to decompression likely results in trivial difference in the Oswestry Disability Index (range 0–100, with higher values indicating greater impairment) with mean difference (MD) 0.86 (95% CI −4.53 to 6.26; moderate COE). Similar results were observed for back and leg pain measured on a scale of 0 to 100, with higher values indicating more severe pain. There was a slightly increased improvement in back pain (2-year follow-up) in the group without fusion shown by MD −5·92 points (95% CI −11.00 to −0.84; moderate COE). There was a trivial difference in leg pain between the groups, slightly favouring the one without fusion, with MD −1.25 points (95% CI −6.71 to 4.21; moderate COE). Our findings at 2-year follow-up suggest that omitting fusion may increase the reoperation rate slightly (OR 1.23; 0.70 to 2.17; low COE). Conclusions Evidence suggests no benefits of adding instrumented fusion to decompression for treating DS. Isolated decompression seems sufficient for most patients. Further RCTs assessing spondylolisthesis stability are needed to determine which patients would benefit from fusion. PROSPERO registration number CRD42022308267.
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Metadata
- Type
- review
- Language
- en
- Landing Page
- https://doi.org/10.1136/jnnp-2022-330158
- https://jnnp.bmj.com/content/jnnp/early/2023/02/26/jnnp-2022-330158.full.pdf
- OA Status
- hybrid
- Cited By
- 25
- References
- 51
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4322491313
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4322491313Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1136/jnnp-2022-330158Digital Object Identifier
- Title
-
Decompression alone versus decompression with instrumented fusion in the treatment of lumbar degenerative spondylolisthesis: a systematic review and meta-analysis of randomised trialsWork title
- Type
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reviewOpenAlex work type
- Language
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enPrimary language
- Publication year
-
2023Year of publication
- Publication date
-
2023-02-27Full publication date if available
- Authors
-
Radek Kaiser, Lucia Kantorová, Alena Langaufová, Simona Slezáková, Dagmar Tučková, Miloslav Klugar, Zdeněk Klézl, Pavel Barša, Jan Cienciala, Richard Hajdúk, Lumír Hrabálek, Roman Kučera, David Netuka, Martin Prýmek, Martin Repko, Martin Smrčka, Jan ŠtulíkList of authors in order
- Landing page
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https://doi.org/10.1136/jnnp-2022-330158Publisher landing page
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https://jnnp.bmj.com/content/jnnp/early/2023/02/26/jnnp-2022-330158.full.pdfDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
hybridOpen access status per OpenAlex
- OA URL
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https://jnnp.bmj.com/content/jnnp/early/2023/02/26/jnnp-2022-330158.full.pdfDirect OA link when available
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Medicine, Decompression, Spondylolisthesis, Meta-analysis, Surgery, Lumbar, Internal medicineTop concepts (fields/topics) attached by OpenAlex
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25Total citation count in OpenAlex
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2025: 16, 2024: 6, 2023: 3Per-year citation counts (last 5 years)
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51Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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