Meta-Analysis of Circumferential Fusion Versus Posterolateral Fusion in Lumbar Spondylolisthesis

Study Design: Literature review and meta-analysis. Summary of Background Data: Posterolateral fusion (PLF) and circumferential fusion (CF) were widely used in the treatment of lumbar spondylolisthesis. There was a great controversy over the preferred fusion method. Objective: We performed a meta-analysis for determining which fusion method was better in lumbar spondylolisthesis. Methods: A systematic search was conducted in MEDLINE, EMBASE, and the Cochrane Collaboration Library from January 1960 to December 2013. Comparative studies were selected according to eligibility criteria. Weighed mean differences (WMDs) and risk differences were calculated. The final strength of evidence was expressed as different levels recommended by the GRADE Working Group. Results: Eight comparative studies were identified. There was less evidence that no significant difference was found between CF and PLF for clinical satisfaction [odds ratio (OR), 0.63; 95% confidence interval (95% CI), 0.30, 1.32; P = 0.22)] and for complication rate (OR, 0.64; 95% CI, 0.23, 1.76; P = 0.39). The PLF was more effective than the CF for the reduction of complication rate for patients with isthmic spondylolisthesis (OR, 0.44; 95% CI, 0.23, 0.86; P = 0.02). There was no significant difference for fusion rate, reoperation rate, operating time, and blood loss. Subanalysis showed that the CF can increase the fusion rate of patients with isthmic spondylolisthesis (OR, 0.12; 95% CI, 0.01, 1.00; P = 0.05). PLF was more effective than CF for the reduction in operating time (WMD = -75.68; 95% CI, -99.00, -52.37; P < 0.00001), and CF was more effective than PLF for the restoration of segment lordosis, disk height, and spondylolisthesis. Conclusions: There was really no difference for clinical satisfaction, complication rate, fusion rate, reoperation rate, operating time, and blood loss. PLF can reduce complication rate and operating time. CF can improve fusion rate for individuals with isthmic spondylolisthesis and restore lumbar alignment. The level of evidence was low.