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 IJCM  Vol.9 No.7 , July 2018
Meta-Analysis of Clinical Outcomes of Lumbar Fusion Surgical Interventions for Degenerative Spondylolisthesis
Abstract: Introduction: Surgical interventions for degenerative spondylolisthesis are varied with comparable claims of success. Fusion based technique is one of the most commonly used surgical interventions in treating this condition. The aim of this meta-analysis is to compare the effectiveness of the Lumbar Interbody Fusion techniques (specifically Posterolateral Interbody approach—PLIF) versus Posterolateral Instrumented Fusion (PLF). The clinical outcomes investigated were: back pain, leg pain, function, Oswestery Disability Index (ODI), Disability Rating Index (DRI), fusion and revision rates if reported. Methods: Combinations of keywords and MeSH terms, where appropriate, were used to search for studies in Medline via Ovid, Embase, Cochrane Library, and Google scholar. The initial search was conducted on 10 August 2016 and updated on 13 June 2017. Eligibility criteria for the studies to be selected for this meta-analysis were: Randomised Controlled Trials (RCTs), cohort and consecutive cases studies that compared at PLIF versus PLF surgical interventions at the lumbar region. Heterogeneity indicators and Forest plot were computed using RevMan 5. Results: Out of the initial hits of 3021, 5 articles were selected as relevant and assessed for risk of bias and then data was extracted and tabulated. These 5 studies reported data from (900 patients’ records, follow up ranges from 6 months to 5 years) undergone one of 2 interventions (PLIF or PLF). The overall effect for ODI and leg pain showed no advantage of any intervention over the other while there was a greater odd ratio of fusion if the operation applied PLIF techniques (Overall Z = 2.86, p = 0.004). Conclusions: There is a need for more high quality clinical trials to compare these two interventions. However, available data indicate that there are comparable results in the main clinical outcomes between PLIF and PLF. PLIF has superior fusion rate which does not seem to affect post-operative pain ratings.
Cite this paper: Aneiba, K. , Garoushi, S. , Elmajee, M. , Elsllabi, M. and Tashani, O. (2018) Meta-Analysis of Clinical Outcomes of Lumbar Fusion Surgical Interventions for Degenerative Spondylolisthesis. International Journal of Clinical Medicine, 9, 590-599. doi: 10.4236/ijcm.2018.97050.
References

[1]   Ha, K.Y., Na, K.H., Shin, J.H. and Kim, K.W. (2008) Comparison of Posterolateral Fusion with and without Additional Posterior Lumbar Interbody Fusion for Degenerative Lumbar Spondylolisthesis. Journal of Spinal Disorders & Techniques, 21, 229-234.
https://doi.org/10.1097/BSD.0b013e3180eaa202

[2]   Higgins, J.P. and Green, S. (2011) Cochrane Handbook for Systematic Reviews of Interventions. John Wiley & Sons, Hoboken.

[3]   Higgins, J.P.T., Thompson, S.G., Deeks, J.J. and Altman, D.G. (2003) Measuring Inconsistency in Meta-Analyses. BMJ, 327, 557-560.
https://doi.org/10.1136/bmj.327.7414.557

[4]   Harbord, R.M. and Higgins, J. (2008) Meta-Regression in Stata. The Stata Journal, 8, 493-519.

[5]   Dehoux, E., Fourati, E., Madi, K., Reddy, B. and Segal, P. (2005) Posterolateral versus Interbody Fusion in Isthmic Spondylolisthesis: Functional Results in 52 Cases with a Minimum Follow-Up of 6 Years. Acta orthopaedica Belgica, 70, 578-582.

[6]   Ekman, P., Moller, H., Tullberg, T., Neumann, P. and Hedlund, R. (2007) Posterior Lumbar Interbody Fusion versus Posterolateral Fusion in Adult Isthmic Spondylolisthesis. Spine, 32, 2178-2183.
https://doi.org/10.1097/BRS.0b013e31814b1bd8

[7]   Lee, G.W., Lee, S.M., Ahn, M.W., Kim, H.J. and Yeom, J.S. (2014) Comparison of Posterolateral Lumbar Fusion and Posterior Lumbar Interbody Fusion for Patients Younger than 60 Years with Isthmic Spondylolisthesis. Spine, 39, E1475-E1480.
https://doi.org/10.1097/BRS.0000000000000596

[8]   Farrokhi, M.R., Rahmanian, A. and Masoudi, M.S. (2012) Posterolateral versus Posterior Interbody Fusion in Isthmic Spondylolisthesis. Journal of Neurotrauma, 29, 1567-1573.
https://doi.org/10.1089/neu.2011.2167

[9]   Musluman, A.M., Yilmaz, A., Cansever, T., Cavusoglu, H., Colak, I., Genc, H.A., et al. (2011) Posterior Lumbar Interbody Fusion versus Posterolateral Fusion with Instrumentation in the Treatment of Low-Grade Isthmic Spondylolisthesis: Midterm Clinical Outcomes. Journal of Neurosurgery: Spine, 14, 488-496.
https://doi.org/10.3171/2010.11.SPINE10281

[10]   Ye, Y.P., Xu, H. and Chen, D. (2013) Comparison between Posterior Lumbar Interbody Fusion and Posterolateral Fusion with Transpedicular Screw Fixation for Isthmic Spondylolithesis: A Meta-Analysis. Archives of Orthopaedic and Trauma Surgery, 133, 1649-1655.
https://doi.org/10.1007/s00402-013-1868-5

[11]   Kunze, B., Drasseck, T. and Kluba, T. (2011) Posterior and Transforaminal Lumbar Interbody Fusion (PLIF/TLIF) for the Treatment of Localised Segment Degeneration of Lumbar Spine. Zeitschrift für Orthopädie und Unfallchirurgie, 149, 312-316.
https://doi.org/10.1055/s-0030-1250689

[12]   Zhou, Z.J., Zhao, F.D., Fang, X.Q., Zhao, X. and Fan, S.W. (2011) Meta-Analysis of Instrumented Posterior Interbody Fusion versus Instrumented Posterolateral Fusion in the Lumbar Spine. Journal of Neurosurgery: Spine, 15, 295-310.
https://doi.org/10.3171/2011.4.SPINE10330

 
 
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