Sugery for Lumbar Isthmic Spondylolisthesis in Adults:A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

ZHAI Sheng ¹ , BAI Jingping ² , XILIN Baoleri ³ , JIN Gele ⁴ , WU Taixiang ⁵ , LIU Guanjian ⁵

1. Medical School of Xinjiang Medical University, Urimqi 830054, China 2. The Third Affiliated Hospital of Xinjiang Medical University 3. The Second Affiliated Hospital of Xinjiang Medical University 4. The First Affiliated Hospital of Xinjiang Medical University 5. Evidence-Based Medicine and Clinical Epidemiology Center, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Spondylolisthesis; Adult isthmic; Spine fusion treatment; Systematic review

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Objective 　To assess the effectiveness of surgical interventions for lumbar isthmic spondylolisthesis in adults.
Methods 　RCTs of surgical treatment for adult lumbar isthmic spondylolisthesis were identified from specialized trials registered in Cochrane Back Group, The Cochrane Library (Issue 2, 2004)，additional electronic search (including MEDLINE (1966 to 2004)，EMBASE (1980 to 2004) and CBM), handsearching for Chinese journals. Two reviewers assessed the quality of the trials and extracted data independently. Meta analysis was conducted using RevMan 4.2.
Results 　Four published trials including a total of 277 patients were included. Three trials compared different operative procedures and one trial considered conservative versus surgical treatment for lumbar isthmic spondylolisthesis in adults. Two trials had limitations of trial design which at times gave considerable potential for bias. As very few studies and patients were included, and different score criteria were used to assess the clinical outcomes in the review, we decided to provide a descriptive summary only. All trials drew a conclusion that lumbar posterolateral fusion for adult isthmic spondylolisthesis could relieve pain and improve clinical outcome. There was no significant difference in fusion rate and improvement of clinical outcomes between different operative procedures. One trial showed that the lumbar posterolateral fusion could improve function and relieve pain more efficiently than an exercise program. Three trials indicated there was no difference in fusion rate and improvement of clinical outcomes between different operative methods. One trial suggested that instrumented posterolateral fusion did not improve fusion rate but increased complication rates, operation time and bleeding loss. Two trials considered the role of decompressive laminectomy and reached a conflicting conclusion.
Conclusions 　There is no adequate evidence about the most effective technique of treatment for adult lumbar isthmic spondylolisthesis. There is limited evidence that the lumbar posterolateral fusion for adult isthmic spondylolisthesis can efficiently relieve pain and improve clinical outcome. There is no evidence that the use of pedicle screw fixation can improve the fusion rate or the clinical outcome. At present, there is no enough evidence available from randomised trials to support the routine clinical use of instrumented fusion for lumbar isthmic spondylolisthesis in adults. As very few studies and patients were included in the review, it was cautious to draw any conclusions from the review. More trials with high quality on methodology are needed.

Citation： ZHAI Sheng,BAI Jingping,XILIN Baoleri,JIN Gele,WU Taixiang,LIU Guanjian. Sugery for Lumbar Isthmic Spondylolisthesis in Adults:A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2005, 05(4): 311-316. doi: Copy

1.	Kim NH, Lee JW. Anterior Interbody Fusion Versus Posterolateral Fusion With Transpedicula Fixation for Isthmic Spondylolisthesis in Adults: A Comparison of Clinical Results[J]. Spine, 1999; 24(8): 812-817.
2.	Beutler WJ, Fredrickson BE, Murtland A, Sweeney CA, Grant WD. Baker D. The Natural History of Spondylolysis and Spondylolisthesis: 45-Year Follow-up Evaluation[J]. Spine, 2003; 28(10): 1 027-1 035.
3.	Lim MR, Yoon SC, Green DW. Symptomatic spondylolysis: diagnosis and treatment[J]. Current Opinion in Pediatrics, 2004; (1): 37-46.
4.	Sakamaki T, Sairyo K, Katoh S, Endo H, Komatsubara S, Sano T, Yasui N. The Pathogenesis of Slippage and Deformity in the Pediatric Lumbar Spine: A Radiographic and Histologic Study using a New Rat In Vivo Model[J]. Spine, 2003; 28(7): 645-650.
5.	Wiltse LL, Widell EH Jr, Jackson DW: Fatigue fracture: the basic lesion is isthmic spondylolisthesis[J]. J Bone Joint Surg Am, 1975; 57(4): 17-22.
6.	Ebraheim NA, Lu J, Hao Y, Biyani A, Yeasting RA. Anatomic considerations of the lumbar isthmus[J]. Spine, 1997; 22(9): 941-945.
7.	Weiner BK, Walker M, Wiley W. The lateral buttress: an anatomic feature of the lumbar pars interarticularis[J]. Spine, 2002; 27(1): 385-387.
8.	Dietrich M, Kurowski P. The importance of mechanical factors in the etiology of spondylolysis: a model analysis of loads and stresses in human lumbar spine[J]. Spine, 1985; 10(6): 532-542.
9.	Grobler LJ, Wiltse LL. Classification, non-operative, and operative treatment of spondylolisthesis, in Frymoyer JW (ed): The Adult Spine: Principles and Practice[M]. New York: Raven Press; 1991. Vol 2: 1 655-1 704.
10.	Frennered AK, Danielson BI, Nachemson AL. Natural history of symptomatic isthmic low-grade spondylolisthesis in children and adolescents: a seven-year follow-up study[J]. J Pediatr Orthop, 1991; 11(2): 209-213.
11.	Saraste H. Long-term clinical and radiological follow-up of spondylolysis and spondylolisthesis[J]. J Pediatr Orthop, 1987; 7(6): 631-638.
12.	Blackburne JS, Velikas EP. Spondylolisthesis in children and adolescents[J]. J Bone Joint Surg Br, 1977; 59-B(4): 490-494.
13.	Sairyo K, Katoh S, Ikata T, Fujii K, Kajinra K, Goel VK. Development of spondylolytic olisthesis in adolescents[J]. Spine, 2001; 1(3): 171-175.
14.	Mihara H. Onari K. Cheng BC. David SM. Zdeblick TA. The biomechanical effects of spondylolysis and its treatment[J]. Spine, 2003; 28(3): 235-238.
15.	Gill GG.Mechanism of nerve-root compression and irritation in backache[J]. Clin Orthop, 1955; 5: 66-81.
16.	Rubeli MU, Grob D. Fusion of spondylolisthesis[J]. Spine, 1992; 6: 577-592.
17.	McNeely ML, Torrance G, Magee DJ.A systematic review of physiotherapy for spondylolysis and spondylolisthesis[J]. Man Ther, 2003; 8: 80-91.
18.	Benzel EC. Spine Surgery: Techniques, Complication Avoidance, and Management[M]. Philadelphia, Pa: Churchill Livingstone; 1998.
19.	Al-Khawashki H, Wasef AS.Combined Dysplastic and Isthmic Spondylolisthesis: Possible Etiology. [Case Reports][J]. Spine, 2001; 26(23): 542-546.
20.	Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials[J]. BMJ, 2001; 323(7 303): 42-46.
21.	Carragee EJ. Single-level posterolateral arthrodesis, with or without posterior decompression, for the treatment of isthmic spondylolisthesis in adults. A prospective, randomized study[J]. J Bone Joint Surg Am,1997; 79(8): 1 175-1 180.
22.	M(o")ller H, Hedlund R. Surgery Versus Conservative Management in Adult Isthmic Spondylolisthesis: A Prospective Randomized Study: Part 1[J]. Spine, 2000; 25(13): 1 711-1 715.
23.	M(o")ller H, Hedlund R.Instrumented and Noninstrumented Posterolateral Fusion in Adult Spondylolisthesis: A Prospective Randomized Study: Part 2[J]. Spine, 2000; 25(13): 1 716-1 721.
24.	Madan S, Boeree NR. Outcome of Posterior Lumbar Interbody Fusion Versus Posterolateral Fusion for Spondylolytic Spondylolisthesis[J]. Spine, 2002; 27(14): 1 536-1 542.
25.	Sinaki M, Lutness MP, Ilstrup DM, Chu CP, Gramse RR. Lumbar spondylolisthesis: retrospective comparison and three-year follow-up of two conservative treatment programs[J]. Arch Phys Med Rehabil, 1989; 70(8): 594-598.
26.	Greenough CG. Results of treatment of lumbar spine disorders: Effects of assessment techniques and confounding factors[J]. Acta Orthop Scand, 1993; 64(Suppl 251): s126-s129.

1. Kim NH, Lee JW. Anterior Interbody Fusion Versus Posterolateral Fusion With Transpedicula Fixation for Isthmic Spondylolisthesis in Adults: A Comparison of Clinical Results[J]. Spine, 1999; 24(8): 812-817.
2. Beutler WJ, Fredrickson BE, Murtland A, Sweeney CA, Grant WD. Baker D. The Natural History of Spondylolysis and Spondylolisthesis: 45-Year Follow-up Evaluation[J]. Spine, 2003; 28(10): 1 027-1 035.
3. Lim MR, Yoon SC, Green DW. Symptomatic spondylolysis: diagnosis and treatment[J]. Current Opinion in Pediatrics, 2004; (1): 37-46.
4. Sakamaki T, Sairyo K, Katoh S, Endo H, Komatsubara S, Sano T, Yasui N. The Pathogenesis of Slippage and Deformity in the Pediatric Lumbar Spine: A Radiographic and Histologic Study using a New Rat In Vivo Model[J]. Spine, 2003; 28(7): 645-650.
5. Wiltse LL, Widell EH Jr, Jackson DW: Fatigue fracture: the basic lesion is isthmic spondylolisthesis[J]. J Bone Joint Surg Am, 1975; 57(4): 17-22.
6. Ebraheim NA, Lu J, Hao Y, Biyani A, Yeasting RA. Anatomic considerations of the lumbar isthmus[J]. Spine, 1997; 22(9): 941-945.
7. Weiner BK, Walker M, Wiley W. The lateral buttress: an anatomic feature of the lumbar pars interarticularis[J]. Spine, 2002; 27(1): 385-387.
8. Dietrich M, Kurowski P. The importance of mechanical factors in the etiology of spondylolysis: a model analysis of loads and stresses in human lumbar spine[J]. Spine, 1985; 10(6): 532-542.
9. Grobler LJ, Wiltse LL. Classification, non-operative, and operative treatment of spondylolisthesis, in Frymoyer JW (ed): The Adult Spine: Principles and Practice[M]. New York: Raven Press; 1991. Vol 2: 1 655-1 704.
10. Frennered AK, Danielson BI, Nachemson AL. Natural history of symptomatic isthmic low-grade spondylolisthesis in children and adolescents: a seven-year follow-up study[J]. J Pediatr Orthop, 1991; 11(2): 209-213.
11. Saraste H. Long-term clinical and radiological follow-up of spondylolysis and spondylolisthesis[J]. J Pediatr Orthop, 1987; 7(6): 631-638.
12. Blackburne JS, Velikas EP. Spondylolisthesis in children and adolescents[J]. J Bone Joint Surg Br, 1977; 59-B(4): 490-494.
13. Sairyo K, Katoh S, Ikata T, Fujii K, Kajinra K, Goel VK. Development of spondylolytic olisthesis in adolescents[J]. Spine, 2001; 1(3): 171-175.
14. Mihara H. Onari K. Cheng BC. David SM. Zdeblick TA. The biomechanical effects of spondylolysis and its treatment[J]. Spine, 2003; 28(3): 235-238.
15. Gill GG.Mechanism of nerve-root compression and irritation in backache[J]. Clin Orthop, 1955; 5: 66-81.
16. Rubeli MU, Grob D. Fusion of spondylolisthesis[J]. Spine, 1992; 6: 577-592.
17. McNeely ML, Torrance G, Magee DJ.A systematic review of physiotherapy for spondylolysis and spondylolisthesis[J]. Man Ther, 2003; 8: 80-91.
18. Benzel EC. Spine Surgery: Techniques, Complication Avoidance, and Management[M]. Philadelphia, Pa: Churchill Livingstone; 1998.
19. Al-Khawashki H, Wasef AS.Combined Dysplastic and Isthmic Spondylolisthesis: Possible Etiology. [Case Reports][J]. Spine, 2001; 26(23): 542-546.
20. Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials[J]. BMJ, 2001; 323(7 303): 42-46.
21. Carragee EJ. Single-level posterolateral arthrodesis, with or without posterior decompression, for the treatment of isthmic spondylolisthesis in adults. A prospective, randomized study[J]. J Bone Joint Surg Am,1997; 79(8): 1 175-1 180.
22. M(o")ller H, Hedlund R. Surgery Versus Conservative Management in Adult Isthmic Spondylolisthesis: A Prospective Randomized Study: Part 1[J]. Spine, 2000; 25(13): 1 711-1 715.
23. M(o")ller H, Hedlund R.Instrumented and Noninstrumented Posterolateral Fusion in Adult Spondylolisthesis: A Prospective Randomized Study: Part 2[J]. Spine, 2000; 25(13): 1 716-1 721.
24. Madan S, Boeree NR. Outcome of Posterior Lumbar Interbody Fusion Versus Posterolateral Fusion for Spondylolytic Spondylolisthesis[J]. Spine, 2002; 27(14): 1 536-1 542.
25. Sinaki M, Lutness MP, Ilstrup DM, Chu CP, Gramse RR. Lumbar spondylolisthesis: retrospective comparison and three-year follow-up of two conservative treatment programs[J]. Arch Phys Med Rehabil, 1989; 70(8): 594-598.
26. Greenough CG. Results of treatment of lumbar spine disorders: Effects of assessment techniques and confounding factors[J]. Acta Orthop Scand, 1993; 64(Suppl 251): s126-s129.

Chinese Journal of Evidence-Based Medicine

Sugery for Lumbar Isthmic Spondylolisthesis in Adults:A Systematic Review

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