The comparison of instrumented and non-instrumented fusion in the treatment of lumbar spondylolisthesis: a meta-analysis.

PURPOSE: This meta-analysis compared whether fusion with or without instrumentation to treat this disease differed with respect to patient-centered outcomes.

METHODS: Medline, Cochrane, EMBASE, Google Scholar data bases were searched for randomized control trials that investigated patients with severe chronic lower back pain resulting from localized lumbar or lumbosacral instability caused by either isthmic spondylolisthesis or degenerative spondylolisthesis. Included randomized studies reported quantitative outcomes for low back pain and functional recovery. The primary outcome was the improvement of function and the secondary outcomes were the improvement of pain, patients' satisfactory level, and the fusion rate.

RESULTS: A significantly lower function change in patients with instrumented compared with non-instrumented from baseline (pooled standardized mean difference; -1.02 (95% CI -1.76 to -0.27); Z -2.67; (P = 0.008)]. There was no significant pain change for patients with instrumented compared with that of non-instrumented from baseline [pooled standardized mean difference; -0.07 (95% CI -1.25 to 1.12); Z -0.11; (P = 0.913)]. There was no significant difference in satisfactory level for patients with instrumented compared with that of non-instrumented [pooled OR; 2.36 (95% CI 0.91-6.11); Z 1.76; (P = 0.078)]. There was significantly higher fusion rate for patients with instrumented compared with that of non-instrumented [pooled OR; 3.28 (95% CI 2.22-4.85); Z 5.96; (P < 0.001)].

CONCLUSIONS: This meta-analysis found that inclusion of fusion surgery with instrumentation provided no benefit as evaluated by patient-reported outcomes in patients with lumbar spondylolisthesis.

LEVEL OF EVIDENCE: Not applicable.