Management for Degenerative Lumbar Spondylolisthesis: a Network Meta-analysis and Systematic Review Basing on Randomized Controlled Trials

Overview

Journal Int J Surg

Specialty General Surgery

Date 2024 Mar 6

PMID 38446872

Authors

Hao Jia

Zhuo Zhang

Jianpu Qin

Lipei Bao

Jun Ao

Hu Qian

Affiliations

Soon will be listed here.

Abstract

Background: Consensus on the various interventions for degenerative lumbar spondylolisthesis (DLS) remains unclear.

Materials And Methods: The authors searched PubMed, Embase, Cochrane Library, Web of Science, and major scientific websites until 01 November 2023, to screen eligible randomized controlled trials (RCTs) involving the treatment of DLS. The seven most common DLS interventions [nonsurgical (NS), decompression only (DO), decompression plus fusion without internal fixation (DF), decompression plus fusion with internal fixation (DFI), endoscopic decompression plus fusion (EDF), endoscopic decompression (ED), and circumferential fusion (360F)] were compared. The primary (pain and disability) and secondary (complications, reoperation rate, operation time, blood loss, length of hospital stay, and satisfaction) outcomes were analyzed.

Results: Data involving 3273 patients in 16 RCTs comparing the efficacy of different interventions for DLS were reported. In terms of improving patient pain and dysfunction, there was a significant difference between surgical and NS. EDF showed the greatest improvement in short-term and long-term dysfunction (probability, 7.1 and 21.0%). Moreover, EDF had a higher complication rate (probability 70.8%), lower reoperation rate (probability, 20.2%), and caused greater blood loss (probability, 82.5%) than other surgical interventions. Endoscopic surgery had the shortest hospitalization time (EDF: probability, 42.6%; ED: probability, 3.9%). DF and DFI had the highest satisfaction scores.

Conclusions: Despite the high complication rate of EDF, its advantages include improvement in pain, lower reoperation rate, and shorter hospitalization duration. Therefore, EDF may be a good option for patients with DLS as a less invasive surgical approach.

Citing Articles

Comparing mid-term outcomes and patient satisfaction between percutaneous endoscopic lumbar discectomy and microendoscopic discectomy for foraminal and extraforaminal lumbar disc herniations: a retrospective matched cohort study.

Liu S, Zhao F, Yin C, Zhu C, Zhao R, Liu G Front Surg. 2025; 12:1554970.

PMID: 40046499 PMC: 11880218. DOI: 10.3389/fsurg.2025.1554970.

Management for degenerative lumbar spondylolisthesis: a network meta-analysis and systematic review basing on randomized controlled trials: Erratum.

Int J Surg. 2024; 110(7):4530.

PMID: 39042081 PMC: 11254283. DOI: 10.1097/JS9.0000000000001929.

References

Wei F, Zhou C, Gao Q, Du M, Gao H, Zhu K . Decompression alone or decompression and fusion in degenerative lumbar spondylolisthesis. EClinicalMedicine. 2022; 51:101559. PMC: 9294267. DOI: 10.1016/j.eclinm.2022.101559. View

Jansen J, Fleurence R, Devine B, Itzler R, Barrett A, Hawkins N . Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: part 1. Value Health. 2011; 14(4):417-28. DOI: 10.1016/j.jval.2011.04.002. View

Weinstein J, Lurie J, Tosteson T, Hanscom B, Tosteson A, Blood E . Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med. 2007; 356(22):2257-70. PMC: 2553804. DOI: 10.1056/NEJMoa070302. View

Cui G, Han X, Wei Y, Liu Y, He D, Sun Y . Robot-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Treatment of Lumbar Spondylolisthesis. Orthop Surg. 2021; 13(7):1960-1968. PMC: 8528995. DOI: 10.1111/os.13044. View

Ruetten S, Komp M, Godolias G . A New full-endoscopic technique for the interlaminar operation of lumbar disc herniations using 6-mm endoscopes: prospective 2-year results of 331 patients. Minim Invasive Neurosurg. 2006; 49(2):80-7. DOI: 10.1055/s-2006-932172. View

Sembrano J, Tohmeh A, Isaacs R . Two-year Comparative Outcomes of MIS Lateral and MIS Transforaminal Interbody Fusion in the Treatment of Degenerative Spondylolisthesis: Part I: Clinical Findings. Spine (Phila Pa 1976). 2016; 41 Suppl 8:S123-32. DOI: 10.1097/BRS.0000000000001471. View

Dias S, Welton N, Caldwell D, Ades A . Checking consistency in mixed treatment comparison meta-analysis. Stat Med. 2010; 29(7-8):932-44. DOI: 10.1002/sim.3767. View

Sengupta D, Herkowitz H . Degenerative spondylolisthesis: review of current trends and controversies. Spine (Phila Pa 1976). 2005; 30(6 Suppl):S71-81. DOI: 10.1097/01.brs.0000155579.88537.8e. View

Wang Y, Kaplar Z, Deng M, Leung J . Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2018; 11:39-52. PMC: 5866399. DOI: 10.1016/j.jot.2016.11.001. View

10.

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339:b2700. PMC: 2714672. DOI: 10.1136/bmj.b2700. View

11.

Ghogawala Z, Dziura J, Butler W, Dai F, Terrin N, Magge S . Laminectomy plus Fusion versus Laminectomy Alone for Lumbar Spondylolisthesis. N Engl J Med. 2016; 374(15):1424-34. DOI: 10.1056/NEJMoa1508788. View

12.

Ghogawala Z, Dunbar M, Essa I . Lumbar spondylolisthesis: modern registries and the development of artificial intelligence. J Neurosurg Spine. 2019; 30(6):729-735. DOI: 10.3171/2019.2.SPINE18751. View

13.

Harrop J, Hilibrand A, Mihalovich K, Dettori J, Chapman J . Cost-effectiveness of surgical treatment for degenerative spondylolisthesis and spinal stenosis. Spine (Phila Pa 1976). 2014; 39(22 Suppl 1):S75-85. DOI: 10.1097/BRS.0000000000000545. View

14.

Jacobsen S, Sonne-Holm S, Rovsing H, Monrad H, Gebuhr P . Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study. Spine (Phila Pa 1976). 2007; 32(1):120-5. DOI: 10.1097/01.brs.0000250979.12398.96. View

15.

Rouse B, Chaimani A, Li T . Network meta-analysis: an introduction for clinicians. Intern Emerg Med. 2016; 12(1):103-111. PMC: 5247317. DOI: 10.1007/s11739-016-1583-7. View

16.

Inose H, Kato T, Yuasa M, Yamada T, Maehara H, Hirai T . Comparison of Decompression, Decompression Plus Fusion, and Decompression Plus Stabilization for Degenerative Spondylolisthesis: A Prospective, Randomized Study. Clin Spine Surg. 2018; 31(7):E347-E352. PMC: 6072383. DOI: 10.1097/BSD.0000000000000659. View

17.

Davis R, Auerbach J, Bae H, Errico T . Can low-grade spondylolisthesis be effectively treated by either coflex interlaminar stabilization or laminectomy and posterior spinal fusion? Two-year clinical and radiographic results from the randomized, prospective, multicenter US.... J Neurosurg Spine. 2013; 19(2):174-84. DOI: 10.3171/2013.4.SPINE12636. View

18.

Bridwell K, Sedgewick T, OBrien M, Lenke L, Baldus C . The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord. 1993; 6(6):461-72. DOI: 10.1097/00002517-199306060-00001. View

19.

Inose H, Kato T, Sasaki M, Matsukura Y, Hirai T, Yoshii T . Comparison of decompression, decompression plus fusion, and decompression plus stabilization: a long-term follow-up of a prospective, randomized study. Spine J. 2021; 22(5):747-755. DOI: 10.1016/j.spinee.2021.12.014. View

20.

Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M . Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015; 350:g7647. DOI: 10.1136/bmj.g7647. View