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Fusion techniques for adult isthmic spondylolisthesis: a systematic review

  • Orthopaedic Surgery
  • Published:
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Abstract

Introduction

Various fusion techniques have been used to treat lumbar spine isthmic spondylolisthesis (IS) in adults, including anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), posterolateral fusion (PLF), and circumferential fusion. The objective of this study was to evaluate which fusion technique provides the best clinical and radiological outcome for adult lumbar IS.

Materials and methods

A systematic review was performed. MEDLINE databases and reference lists of selected articles were searched. Inclusion criteria stated that the studies had to be controlled and that they compared clinical and radiological outcomes of various fusion techniques for treating adult IS. Exclusion criteria were use of only one treatment and non-English language articles. Two reviewers independently extracted relevant data from each included study. Statistical comparisons were made when appropriate.

Results

Nine studies that compared two surgical approaches to IS were included in this systematic review. Three were prospective studies, and six were retrospective studies. Two studies compared ALIF with instrumented PLF and ALIF with percutaneous pedicle screw fixation, two studies compared ALIF and TLIF, and five studies compared PLIF and PLF. ALIF was superior to other techniques regarding restoration of disc height, segmental lordosis, and whole lumbar lordosis. TLIF had lower complication rates. ALIF combined with PLF showed lower nonfusion rates than other techniques. However, there were no significant differences in clinical outcomes between any two techniques.

Conclusion

Compared to other fusion techniques, TLIF shows fewer complications, ALIF shows better sagittal alignment, and circumferential fusion showed better fusion rates. It was difficult to make recommendations about the optimal approach because of the methodological variance in the publications.

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Conflict of interest

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Spinal Surgery, East Hospital, Tongji University School of Medicine, 150# Jimo RD, Pudong New Area, Shanghai, 200120, China

    Shan-Jin Wang, Ying-Chao Han, Xiao-Ming Liu, Bin Ma, Wei-Dong Zhao, De-Sheng Wu & Jun Tan

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  1. Shan-Jin Wang
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  2. Ying-Chao Han
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Correspondence to De-Sheng Wu or Jun Tan.

Additional information

Shan-Jin Wang, Ying-Chao Han and Xiao-Ming Liu contributed equally to this work.

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Wang, SJ., Han, YC., Liu, XM. et al. Fusion techniques for adult isthmic spondylolisthesis: a systematic review. Arch Orthop Trauma Surg 134, 777–784 (2014). https://doi.org/10.1007/s00402-014-1985-9

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  • DOI: https://doi.org/10.1007/s00402-014-1985-9

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