A Meta-analysis Of Posterolateral Fusion Versus 360°Circumferential Fusion In Lumbar Spondylolisthesis

Background:Posterolateral fusion (PLF) and circumferential fusion (CF) are considered as main operation methods for lumbar spondylolisthesis.Objective:To evaluate the safety and effective of posterolateral fusion and circumferential fusion in lumbar spondylolisthesis.Methods:The literature about posterolateral fusion and circumferential fusion in lumbar spondylolisthesis by searching PubMed, the Cochrane Library, Web of Knowledge, Wanfang database, VIP, and CNKI from their inception date to July 2014. Meta-analysis was performed by Revman 5.2 software.Results:Three RCTs and four retrospective studies were indentified. There were significant difference between PLF and CF for operating time (MD=-71.08,95%CI:-122.63～-19.54, p=0.007), postoperative hospital stay (MD=-0.98,95%CI:-1.85～-0.11, p=0.03), blood loss(MD =-174.66,95%CI:-304.59--44.72, p=0.008), fusion rate(OR=0.12,95% CI:0.04-0.35, p<0.0001), Physical Function after follow-up 6months(MD=24.87,95%CI:22.84～26.90, p<0.00001),12 months (MD=-1.21,95%CI:-2.13～-0.29, p=0.01),24 months(MD=-8.66, 95%CI:-9.54～-7.78, p<0.00001), Physical Pain after follow-up 6months(MD=-5.09,95%CI:-6.18～-4.00, p<0.00001)、12months (MD=-8.28,95%CI:-9.24～-7.32, p<0.00001),24months (MD=-9.91,95%CI:-10.83～-8.99, p<0.00001), Oswestry disability after follow-up 6months (MD= 8.08,95%CI:1.23～14.94, p=0.02),12months(MD= 6.72,95%CI:6.02-7.42, p<0.00001), 24months(MD= 4.94,95%CI:4.30～5.57, p<0.00001). However, there were no-significant difference in postoperative complications(OR=1.16,95%CI:0.51～2.62, p=0.72), satisfaction rate(OR= 0.47,95%CI:0.19～1.17, p=0.10), VAS after follow-up 6months (MD=-0.70, 95%CI:-1.39～-0.01, p=0.05),12months (MD=-0.50,95%CI:-1.10-0.10, p=0.10),24 months (MD=-0.20,95%CI:-0.76-0.36, p=0.48), JOA (OR= 0.35,95%CI:0.12-1.00, p=0.05), and AAOS after follow-up 24months (MD= 4.00,95%CI:-0.37-8.37, p=0.07).Conclusions:Compared with Circumferential fusion, Posterolateral fusion is a better choice for Lumbar spondylolisthesis patients.