Surgical management of spondylolisthesis-intentional reduction or in situ fusion: a meta-analysis

Objective background context: To clarify the potential difference of surgical management with intentional reduction or in situ fusion for spondylolisthesis. Methods: A comprehensive search of the NGC, the Cochrane Library, WOS, PubMed, Embase databases was conducted to identify eligible studies by the date of October 1, 2017. Three authors independently selected qualified studies, assessed methodological quality, and extracted the data. Results: 17 studies involved 992 patients were eligible for this meta-analysis (546 in reduction group and 446 in in situ fusion group). There were no significant differences in Visual Analog Scale (VAS), Japanese Orthopedic Association (JOA) scale, fusion rates and complication rates between two groups. In addition, regarding to operative time, our study indicated that in situ fusion group was associated with shorter operative time compared with reduction group. Reduction group was correlated with lower mean ODI, shorter length of stay (in low-grade), less slippage and blood loss (in high-grade) compared with in situ fusion group. Conclusion: Surgical interventions with intentional reduction did not significantly improve patient-reported outcomes, main clinical outcomes or reduce perioperative complications in low-grade spondylolisthesis. Therefore, intentional reduction may not be a requirement in the surgical management of spondylolisthesis. Randomized control studies with relatively large population and long-term follow up should be carried out to clarify this issue in the future.