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The Surgical Management of Degenerative Lumbar Spondylolisthesis: A Systematic Review

Martin, C Ryan BSc*; Gruszczynski, Adam T. BSc†; Braunsfurth, Heike A.‡; Fallatah, Salah M. MD, FRCS§; O'Neil, Joseph MD, FRCS§; Wai, Eugene K. MSc, MD, FRCS§

doi: 10.1097/BRS.0b013e3180bc219e

Study Design. Systematic review.

Objective. To identify whether there is an advantage to instrumented or noninstrumented spinal fusion over decompression alone for patients with degenerative lumbar spondylolisthesis.

Summary of Background Data. The operative management of degenerative spondylolisthesis includes spinal decompression with or without instrumented or noninstrumented spinal fusion. Evidence on the operative management of degenerative spondylolisthesis is still divisive.

Methods. Relevant RCT and comparative observational studies between 1966 and June 2005 were identified. Abstracted outcomes included clinical outcome, reoperation rate, and solid fusion status. Analyses were separated into: 1) fusion versus decompression alone and 2) instrumented fusion versus noninstrumented fusion.

Results. Thirteen studies were included. The studies were generally of low methodologic quality. A satisfactory clinical outcome was significantly more likely with fusion than with decompression alone (relative risk, 1.40; 95% confidence interval, 1.04–1.89; P < 0.05). The use of adjunctive instrumentation significantly increased the probability of attaining solid fusion (relative risk, 1.37; 95% confidence interval, 1.07–1.75; P < 0.05), but no significant improvement in clinical outcome was recorded (relative risk, 1.19; 95% confidence interval, 0.92–1.54). There was a nonsignificant trend toward lower repeat operations with fusion compared with both decompression alone and instrumented fusion.

Conclusion. Spinal fusion may lead to a better clinical outcome than decompression alone. No conclusion about the clinical benefit of instrumenting a spinal fusion could be made. However, there is moderate evidence that the use of instrumentation improves the chance of achieving solid fusion.

A systematic review of the surgical management of degenerative spondylolisthesis. Fusion lead to a better clinical outcome than decompression alone. The use of supplementary instrumentation significantly increased the probability of achieving solid fusion but no significant change in clinical outcome occurred.

From the *University of Ottawa, Faculty of Medicine, Ottawa, ON, Canada; †Ottawa Health Research Institute, Ottawa, ON, Canada; ‡University of Bochum, Faculty of Medicine, Bochum Germany; and §University of Ottawa, Division of Orthopaedic Surgery, Ottawa, ON, Canada.

Acknowledgment date: November 21, 2006. Acceptance date: January 2, 2007.

Sources of support: Canadian Institute of Health Research and University of Ottawa, Faculty of Medicine.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

Federal funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Eugene K. Wai, MSc, MD, Ottawa Hospital, 1053 Carling, Ottawa, ON, Canada, K1Y 4E9; E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.