Meta-analysis Of The Clinical Effect Of Reduction Interbody Fusion And In Situ Interbody Fusion For Low-grade Lumbar Spondylolisthesis

Objective:The meta-analysis method was adopted to compare the clinical efficacy and radiographic results of reduced intervertebral fusion and in situ intervertebral fusion in the treatment of low-grade degenerative lumbar spondylolisthesis.The clinical value of two different surgical strategies was evaluated as mild lumbar spondylolisthesis Provides clinical evidence for evidence-based medicine.Methods:The EMBASE,PubMed and Cochrane CENTRAL databases were searched by computer,and the specialized journals such as "SPINE" and"EUROPEAN SPINE JOURNAL" were searched manually.The key words were"spondylolisthesis","interbody fusion","spinal Fusion","in situ" and "reduction" and so on.All randomized controlled studies on reduction interbody fusion and in situ interbody fusion in the treatment of mild lumbar spondylolisthesis were included.Among them,sex ratio,excellent and good rate of operation and bone fusion rate were two-classified variables,Relative Risk,Odds Ratio or Risk Difference were selected,and other outcome evaluation indexes were continuous variables,weighted mean difference or standardized mean difference.The general characteristics(the age and sex),clinical efficacy(operation time,intraoperative blood loss,hospital stay,excellent and good rate of operation and operative complications),international general scoring standards(the JOA,VAS and ODI scores),imaging findings(bony fusion rate,lumbar spondylolisthesis rate and segmental lumbar kyphosis angle)were compared and analyzed.The heterogeneity test uses Q test and 12 test.P<0.1 or 12>50%indicates that there is significant heterogeneity.At this time,the random effect model is selected,otherwise,the fixed effect model is selected.Publication bias was evaluated by funnel chart,Begg and Egger' s Test.The sensitivity analysis adopted the methods of eliminating one by one,changing the combined effect and changing the effect model.Review Manager software was adopted for statistical calculationResults:A total of 7 original studies met the inclusion criteria,including 3 randomized controlled studies and 4 case-control studies,including 415 patients,including reduction group(n=217)and in situ group(n=198).The age distribution of the subjects was 84 years old,and the shortest follow-up time was 24 months?There was no significant difference in age between the reduction group and the in situ group[MD=0.32,95%CI(-0.86,1.50),P=0.60].?There was no significant difference in sex ratio between the two groups[OR=0.78,95%CI(0.53,1.17),P=0.23].?the operation time of the two groups was the same[MD=6.31,95%CI(-3.31,15.93),P=0.20].However,the conclusion of sensitivity analysis showed that the effect was changed,and the heterogeneity was taken into account in the literature itself.?There was no significant difference in intraoperative blood loss between the two groups[MD=12.42,95%CI(-11.33,16.17),P=0.31].?The average hospitalization time in the reduction group was less than that in the orthotopic group[MD=-0.84,95%CI(-1.13,-0.55),P<0.00001].?The bone fusion rates of the two different surgical strategies were similar[OR=1.70,95%CI(0.69,4.17),P=0.24]?There was no significant difference in the excellent and good rate between the reduction group and the in situ group[OR=0.91,95%CI(0.45,1.85),P=0.80].?The postoperative complications of the two groups were similar[OR=0.91,95%CI(0.45,1.85),P=0.80].?The rate of lumbar spondylolisthesis at the last follow-up in the reduction group was better than that in the in situ group[MD=-12.14,95%CI(-13.51,-10.76),P<0.00001].?The angle recovery of segmental kyphosis in the reduction group was better than that in the in situ group at the last follow-up[MD=3.58,95%CI(1.95,5.22),P<0.0001].11 The improvement of JOA score before and after operation in the two groups was similar[MD=0.03,95%CI(-0.53,0.58),P=0.93]12 There was no significant difference in the improvement of VAS score before and after operation between the two groups[MD=-0.03,95%CI(-0.23,0.16),P=0.74]13 There was no significant difference in the improvement of ODI score before and after operation between the two groups[MD=-1.02,95%CI(-3.59,1.54),P=0.43].Conclusions:1.Reduction interbody fusion and in situ interbody fusion for low-grade lumbar spondylolisthesis can achieve good results in the short and medium term.2.Compared with in-situ fusion,reduction fusion did not significantly increase the operation time and intraoperative blood loss,but prominently shortened the hospitalization time.3.Reduction interbody fusion could immediately correct the degrees of spondylolisthesis and segmental lumbar lordosis.4.Both reduction interbody fusion and in-situ interbody fusion could effectively maintain the stability of postoperative spinal structure for a long time.