Decompression alone versus decompression with instrumented
fusion in the treatment of lumbar degenerative
spondylolisthesis: a systematic review and meta-analysis of
randomised trials

J 2023

Decompression alone versus decompression with instrumented fusion in the treatment of lumbar degenerative spondylolisthesis: a systematic review and meta-analysis of randomised trials

KAISER, Radek, Lucia KANTOROVÁ, Alena LANGAUFOVÁ, Simona SLEZÁKOVÁ, Dagmar TUCKOVA et. al.

Basic information

Original name

Decompression alone versus decompression with instrumented fusion in the treatment of lumbar degenerative spondylolisthesis: a systematic review and meta-analysis of randomised trials

Authors

KAISER, Radek (203 Czech Republic, guarantor), Lucia KANTOROVÁ (703 Slovakia, belonging to the institution), Alena LANGAUFOVÁ (203 Czech Republic, belonging to the institution), Simona SLEZÁKOVÁ (203 Czech Republic, belonging to the institution), Dagmar TUCKOVA (203 Czech Republic), Miloslav KLUGAR (203 Czech Republic, belonging to the institution), Zdenek KLEZL (203 Czech Republic), Pavel BARSA (203 Czech Republic), Jan CIENCIALA (203 Czech Republic, belonging to the institution), Richard HAJDUK (203 Czech Republic), Lumir HRABALEK (203 Czech Republic), Roman KUCERA (203 Czech Republic), David NETUKA (203 Czech Republic), Martin PRÝMEK (203 Czech Republic, belonging to the institution), Martin REPKO (203 Czech Republic, belonging to the institution), Martin SMRČKA (203 Czech Republic, belonging to the institution) and Jan STULIK (203 Czech Republic)

Edition

Journal of Neurology, Neurosurgery, and Psychiatry, London, BMJ PUBLISHING GROUP, 2023, 0022-3050

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30210 Clinical neurology

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 11.000 in 2022

RIV identification code

RIV/00216224:14110/23:00130599

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1136/jnnp-2022-330158

UT WoS

000943805600001

Keywords in English

lumbar degenerative spondylolisthesis; decompression; instrumented fusion

Abstract

V originále

ObjectiveTo determine the efficacy of adding instrumented spinal fusion to decompression to treat degenerative spondylolisthesis (DS). DesignSystematic review with meta-analysis. Data sourcesMEDLINE, 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 selectionRandomised 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). ResultsWe 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 center dot 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). ConclusionsEvidence 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.

Citovat

KAISER, Radek, Lucia KANTOROVÁ, Alena LANGAUFOVÁ, Simona SLEZÁKOVÁ, Dagmar TUCKOVA, Miloslav KLUGAR, Zdenek KLEZL, Pavel BARSA, Jan CIENCIALA, Richard HAJDUK, Lumir HRABALEK, Roman KUCERA, David NETUKA, Martin PRÝMEK, Martin REPKO, Martin SMRČKA and Jan STULIK. Decompression alone versus decompression with instrumented fusion in the treatment of lumbar degenerative spondylolisthesis: a systematic review and meta-analysis of randomised trials. Journal of Neurology, Neurosurgery, and Psychiatry. London: BMJ PUBLISHING GROUP, 2023, vol. 94, No 8, p. 657-666. ISSN 0022-3050. Available from: https://dx.doi.org/10.1136/jnnp-2022-330158.

@article{2275825,
   author = {Kaiser, Radek and Kantorová, Lucia and Langaufová, Alena and Slezáková, Simona and Tuckova, Dagmar and Klugar, Miloslav and Klezl, Zdenek and Barsa, Pavel and Cienciala, Jan and Hajduk, Richard and Hrabalek, Lumir and Kucera, Roman and Netuka, David and Prýmek, Martin and Repko, Martin and Smrčka, Martin and Stulik, Jan},
   article_location = {London},
   article_number = {8},
   doi = {http://dx.doi.org/10.1136/jnnp-2022-330158},
   keywords = {lumbar degenerative spondylolisthesis; decompression; instrumented fusion},
   language = {eng},
   issn = {0022-3050},
   journal = {Journal of Neurology, Neurosurgery, and Psychiatry},
   title = {Decompression alone versus decompression with instrumented fusion in the treatment of lumbar degenerative spondylolisthesis: a systematic review and meta-analysis of randomised trials},
   url = {https://jnnp.bmj.com/content/early/2023/02/26/jnnp-2022-330158},
   volume = {94},
   year = {2023}
}

TY  - JOUR
ID  - 2275825
AU  - Kaiser, Radek - Kantorová, Lucia - Langaufová, Alena - Slezáková, Simona - Tuckova, Dagmar - Klugar, Miloslav - Klezl, Zdenek - Barsa, Pavel - Cienciala, Jan - Hajduk, Richard - Hrabalek, Lumir - Kucera, Roman - Netuka, David - Prýmek, Martin - Repko, Martin - Smrčka, Martin - Stulik, Jan
PY  - 2023
TI  - Decompression alone versus decompression with instrumented fusion in the treatment of lumbar degenerative spondylolisthesis: a systematic review and meta-analysis of randomised trials
JF  - Journal of Neurology, Neurosurgery, and Psychiatry
VL  - 94
IS  - 8
SP  - 657-666
EP  - 657-666
PB  - BMJ PUBLISHING GROUP
SN  - 00223050
KW  - lumbar degenerative spondylolisthesis
KW  - decompression
KW  - instrumented fusion
UR  - https://jnnp.bmj.com/content/early/2023/02/26/jnnp-2022-330158
N2  - ObjectiveTo determine the efficacy of adding instrumented spinal fusion to decompression to treat degenerative spondylolisthesis (DS). DesignSystematic review with meta-analysis. Data sourcesMEDLINE, 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 selectionRandomised 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). ResultsWe 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 center dot 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). ConclusionsEvidence 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.
ER  -

KAISER, Radek, Lucia KANTOROVÁ, Alena LANGAUFOVÁ, Simona SLEZÁKOVÁ, Dagmar TUCKOVA, Miloslav KLUGAR, Zdenek KLEZL, Pavel BARSA, Jan CIENCIALA, Richard HAJDUK, Lumir HRABALEK, Roman KUCERA, David NETUKA, Martin PRÝMEK, Martin REPKO, Martin SMRČKA and Jan STULIK. Decompression alone versus decompression with instrumented fusion in the treatment of lumbar degenerative spondylolisthesis: a systematic review and meta-analysis of randomised trials. \textit{Journal of Neurology, Neurosurgery, and Psychiatry}. London: BMJ PUBLISHING GROUP, 2023, vol.~94, No~8, p.~657-666. ISSN~0022-3050. Available from: https://dx.doi.org/10.1136/jnnp-2022-330158.

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