Instrumented Versus Noninstrumented Spinal Fusion for Degenerative Lumbar Spondylolisthesis

Abstract

Study Design: Systematic review. Objective: This systematic review compares radiographic and clinical outcomes between instrumented and noninstrumented posterolateral lumbar spine fusions for the treatment of degenerative lumbar spondylolisthesis. Summary of Background Data: The optimal method of fusion for instability from degenerative lumbar spondylolisthesis remains to be an area of debate amongst spine surgeons. There are no prior comprehensive systematic review of comparative studies that compares outcomes between instrumented and noninstrumented posterolateral spine fusions for the treatment of degenerative lumbar spondylolisthesis. Materials and Methods: A systematic review was registered with PROSPERO and performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using the PubMed, SCOPUS, and Ovid MEDLINE databases. All level I–III comparative studies published in the English language investigating the clinical outcomes between instrumented and noninstrumented posterolateral spine fusions for the treatment of degenerative lumbar spondylolisthesis were included. Results: Seven studies (672 patients, 274 noninstrumented, 398 instrumented) were analyzed. One randomized study was level I evidence, 2 randomized studies were level II, and 4 nonrandomized studies were level III. Mean follow-up ranged from 1.4 to 5.9 years. Instrumented patients had a higher rate of solid fusion (87.6% vs. 77.1%, P=0.023) and a lower rate of definitive pseudarthrosis (5.3% vs. 19.9%, P<0.001). However, there was no difference in overall functional improvement at final follow-up between the 2 treatment groups (75.0% vs. 81.7%, P=0.258). In addition, there was no difference in reoperation or complication rates. Conclusions: For the treatment of degenerative lumbar spondylolisthesis, there are significantly higher rates of fusion among patients undergoing instrumented posterolateral fusion compared with noninstrumented posterolateral fusion. However, there is no difference in overall functional improvement, pain-related outcome scores, reoperation rates, or complication rates between the 2 treatment groups. Level of Evidence: Level III—systematic review of level I–III studies.

Decompression alone versus decompression with instrumented fusion in the treatment of lumbar degenerative spondylolisthesis: a systematic review and meta-analysis of randomised trials

“…Therefore, we included both techniques in the analysis. We excluded historical studies comparing cases after non-instrumented fusion due to its lower rate of solid fusion and higher rate of definitive pseudarthrosis 38…”

“…We excluded historical studies comparing cases after noninstrumented fusion due to its lower rate of solid fusion and higher rate of definitive pseudarthrosis. 38 According to the latest recommendations of The North American Spine Society from 2016 based on older observational data, simple decompression may be considered for symptomatic DS with low-grade (up to 20% anteroposterior caudal vertebral body) slip unresponsive to conservative treatment. The authors noted that in the case of preserving medial structures, it leads to equivalent results as instrumented decompression.…”

Decompression with or without Fusion for Lumbar Synovial Cysts—A Systematic Review and Meta-Analysis

“…In addition, no comparisons could be made among fusion techniques (instrumented vs. non-instrumented), as not all studies explicitly discriminated between techniques [ 9 , 11 , 34 ]. In included two studies [ 35 , 36 ], only non-instrumented fusions were performed, while in the other studies, variable combinations of both instrumented and non-instrumented fusion were used. However, the only outcome parameters that could be analyzed in relation to these studies were reoperation rate and preoperative spondylolisthesis, respectively.…”

Instrumented Versus Uninstrumented Posterolateral Fusion for Lumbar Spondylolisthesis

“…In a recent systematic review based on 7 studies including 236 patients treated with uninstrumented fusion and 338 patients treated with instrumented fusion due to degenerative spondylolisthesis, Hirase et al 28 reported a fusion rate of 77.1% in the uninstrumented group and 87.6% in the instrumented group, with an average reoperation rate of 11.9% in the uninstrumented group and 14.4% in the instrumented group. These findings are in sharp contrast to our fusion and reoperation rates.…”