Abstract:

BACKGROUND: Fusion treatment is an important part in lumbar spondylolisthesis surgery. The major aim of fusion is osseous junctions among intervertebral joint so as to establish and maintain strong spinal stability. The common fusion manner of lumbar spondylolisthesis is posterolateral fusion and interbody fusion. Although above two fusion manners have good clinical effects and their complications are less, it is still controversial on the optimal fusion manner of lumbar spondylolisthesis.
OBJECTIVE: To assess the clinical outcome of adult lumbar spondylolisthesis treated by posterolateral fusion 
and interbody fusion.
METHODS: According to Cochrane systematic review method, Medline (from 2000 to March 2014), PubMed (from 2000 to March 2014), and Springerlink (from 2000 to March 2014) were retrieved by computer. Literatures were collected by hand. Only English literatures were included. All related randomized controlled trial and high quality cohort studies were collected. Meta-analysis was performed utilizing Revmen 5.2.0 software offered by Cochrane cooperative network. Thus, we attainted the literatures related to the clinical and imaging outcomes.
RESULTS AND CONCLUSION: Through completely retrieving and screening, this study gained two randomized controlled trials and four high quality cohort studies. The results of meta-analysis showed that there were no significant differences between posterolateral and interbody fusion groups in last low back visual analogue scale [weighted mean difference (WMD)=0.32, 95% confidence interval (-0.89, 1.52), P=0.60], the last leg visual analogue scale [WMD=-0.24, 95% confidence interval (-0.49, 0.02), P=0.07], back pain ODI scores [WMD=4.18, 95% confidence interval (-0.30, 8.65), P=0.07], the postoperative satisfication degree [odd ratio (OR)=0.86, 95% confidence interval (0.46, 1.62), P=0.65] and postoperative early complication rate [OR=0.88, 95% confidence interval (0.44, 1.78), P=0.73]. The fusion rate of interbody fusion group was obviously higher than the posterolateral fusion group [OR=0.29, 95% confidence interval (0.15, 0.55), P=0.000 1]. Complication rate was higher in the posterolateral fusion group than interbody fusion group [OR=2.58, 95% confidence interval (1.12, 5.95), P=0.03]. Low back pain, leg pain and function recovery were better in both fusion groups after treatment compared with before treatment. These data indicated that fusion rate was obviously higher in the interbody fusion group than in the posterolateral fusion group. Posterolateral fusion group showed high incidence of long-term complications. There were no evident differences in other indexes between the two groups.

Key words: lumbar vertebrae, spinal fusion, internal fixators, pain measurement