Surgical versus non-surgical treatment of degenerative lumbar spondylolisthesis: systematic review of randomized control trials.
Keywords:
spondylolisthesis, degenerative, surgical treatment, conservative treatment, systematic review.Abstract
Background: The best management for degenerative spondylolisthesis patients is still controversial. Low-grade spondylolisthesis without neurologic deficits used to be treated non-surgically as a first-line. Many studies stated that in patients with degenerative spondylolisthesis with or without spinal stenosis, surgery had superior outcomes. The aim of this systematic review was to describe the effectiveness of surgery versus conservative treatment for lumbar degenerative spondylolisthesis.
Methods: A comprehensive literature search was performed for relevant studies in Medline, EMBASE, CINAHL, Scopus, Centre for Review and Dissemination databases and Cochrane databases were searched. The search included English studies, and all conservative and surgical interventions were included.
Results: Two studies met the inclusion criteria. The number of patients was 650 (355 treated with surgical intervention and 295 treated conservatively). Surgery was found to be more effective than conservative care in the two studies.
Conclusion: Patients with lumbar degenerative spondylolisthesis treated with surgery had significantly better results in pain and function compared with patients treated with nonoperative treatment.
The study is retrospectively registered.
Level of evidence: II
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References
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Lafian AM, Torralba KD. (2018): Lumbar Spinal Stenosis in Older Adults- Rheum Dis Clin North Am.,44(3),501-512
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Bydon M, Alvi MA, Goyal A. (2019): Degenerative Lumbar Spondylolisthesis: Definition, Natural History, Conservative Management, and Surgical Treatment - Neurosurg Clin N Am., 30(3), 299-304
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Samuel Andre M, Moore Harold G, Cunningham Matthew E. (2017):Treatment for degenerative lumbar spondylolisthesis: current concepts and new evidence - Curr Rev Musculoskelet Med,10(4), 521–529
Puntumetakul R, Saiklang P, Tapanya W, Chatprem T, Kanpittaya J, Arayawichanon P, Boucaut R. (2021): The Effects of Core Stabilization Exercise with the Abdominal Drawing-in Maneuver Technique versus General Strengthening Exercise on Lumbar Segmental Motion in Patients with Clinical Lumbar Instability: A Randomized Controlled Trial with 12-Month Follow-Up- Int J Environ Res Public Health, 23;18(15),7811
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Kneis S, Bruetsch V, Dalin D, Hubbe U, Maurer C. (2019): Altered postural timing and abnormally low use of proprioception in lumbar spinal stenosis pre- and post- surgical decompression - BMC Musculoskelet Disord., 1;20(1),183
Dunn AS, Baylis S, Ryan D. (2009): Chiropractic management of mechanical low back pain secondary to multiple-level lumbar spondylolysis with spondylolisthesis in a United States Marine Corps veteran: a case report - J Chiropr Med, 8(3),125–130
Birkmeyer NJ, Weinstein JN, Tosteson AN, et al. (2002): Design of the Spine patient outcomes research trial (SPORT)- Spine (Phila Pa 1976), 27(12),1361–1372
Matz PG, Meagher RJ, Lamer T, et al. (2016): Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis - Spine J,16(3), 439–448
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Wells GA, Shea B, O’Connell D, et al. (2001):The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in metaanalyses - Available at: http://www.ohri.ca/programs/clinical_ epidemiology/oxford.htm.
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Xu F, Tian Z, Fu C, Yao L, Yan M, Zou C, Liu Y, Wang Y. (2020): Mid-lumbar traumatic spondyloptosis without neurological deficit: A case report and literature review - Medicine (Baltimore), 99(12), e19578 doi: 10.1097/MD.0000000000019578
Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT. 1997 Volvo Award winner in clinical studies. (1997): Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation - Spine (Phila Pa 1976), 22(24), 2807-2812
Wei FL, Zhou CP, Liu R, et al. (2021): Management for lumbar spinal stenosis: A network meta-analysis and systematic review - Int J Surg., 85,19-28
Bridwell KH, Sedgewick TA, O’Brien MF, Lenke LG, Baldus C. (1993): The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis - J Spinal Disord, 6, 461–472
Herkowitz HN, Kurz LT. (1991): Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis - J Bone Joint Surg Am., 73, 802–808
Brox JI, Reikeras O, Nygaard O, et al. (2006): Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study – Pain,122 (1–2), 145–155
Brox JI, Sorensen R, Friis A, et al. (2003): Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration – Spine, 28(17),1913–1921
Fairbank J, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R. Spine Stabilization Trial Group. (2005): Randomized controlled trial to compare surgical stabilization of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilization trial – BMJ, 330(7502),1233.
Fritzell P, Hagg O, Wessberg P, Nordwall A. (2002): Swedish Lumbar Spine Study Group. Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish lumbar spine study group – Spine,27(11),1131–1141
Fritzell P, Hagg O, Wessberg P, Nordwall A. (2001): Swedish Lumbar Spine Study Group. 2001 Volvo Award Winner in Clinical Studies: lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group – Spine, 26(23), 2521–2532, discussion 2532–2534
Gaetani P, Aimar E, Panella L, et al. (2006): Functional disability after instrumented stabilization in lumbar degenerative spondylolisthesis: a follow-up study - Funct Neurol, 21, 31–37
Ghogawala Z, Benzel EC, Amin-Hanjani S, et al. (2004): Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative grade I spondylolisthesis - J Neurosurg Spine,1, 267–272
Kornblum MB, Fischgrund JS, Herkowitz HN, Abraham DA, Berkower DL, Ditkoff JS. (2004): Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion and pseudarthrosis – Spine,29, 726–733, discussion 733–734
Pratt RK, Fairbank JC, Virr A. (2002):The reliability of the Shuttle Walking Test, the Swiss Spinal Stenosis Questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the assessment of patients with lumbar spinal stenosis – Spine, 27, 84–91
Stucki G, Daltroy L, Liang MH, Lipson SJ, Fossel AH, Katz JN. (1996): Measurement properties of a self-administered outcome measure in lumbar spinal stenosis – Spine, 21, 796–803
Holmes C, Elder BD, Ishida W, Perdomo-Pantoja A, Locke J, Cottrill E, Lo SL, Witham TF. (2020): Comparing the efficacy of syngeneic iliac and femoral allografts with iliac crest autograft in a rat model of lumbar spinal fusion - J Orthop Surg Res., 15(1), 410
Jacobs WC, Rubinstein SM, Koes B, van Tulder MW, Peul WC. (2013): Evidence for surgery in degenerative lumbar spine disorders - Best Pract Res Clin Rheumatol. 27(5), 673-684
Lafian AM, Torralba KD. (2018): Lumbar Spinal Stenosis in Older Adults- Rheum Dis Clin North Am.,44(3),501-512
Jacobsen S, Sonne-Holm S, Rovsing H, et al. (2007): Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study - Spine (Phila Pa 1976),32(1),120–125
Bydon M, Alvi MA, Goyal A. (2019): Degenerative Lumbar Spondylolisthesis: Definition, Natural History, Conservative Management, and Surgical Treatment - Neurosurg Clin N Am., 30(3), 299-304
Sengupta Dilip K, Herkowitz Harry N. (2005): Degenerative spondylolisthesis: review of current trends and controversies - Spine (Phila Pa 1976),30(6 Suppl), S71–S81
García-Ramos CL, Valenzuela-González J, Baeza-Álvarez VB, Rosales-Olivarez LM, Alpízar-Aguirre A, Reyes-Sánchez A. (2020): Lumbar degenerative spondylolisthesis II: treatment and controversies - Acta Ortop Mex.,34(6), 433-440
Samuel Andre M, Moore Harold G, Cunningham Matthew E. (2017):Treatment for degenerative lumbar spondylolisthesis: current concepts and new evidence - Curr Rev Musculoskelet Med,10(4), 521–529
Puntumetakul R, Saiklang P, Tapanya W, Chatprem T, Kanpittaya J, Arayawichanon P, Boucaut R. (2021): The Effects of Core Stabilization Exercise with the Abdominal Drawing-in Maneuver Technique versus General Strengthening Exercise on Lumbar Segmental Motion in Patients with Clinical Lumbar Instability: A Randomized Controlled Trial with 12-Month Follow-Up- Int J Environ Res Public Health, 23;18(15),7811
Wang Y, Huang K. (2022): Research progress of diagnosing methodology for lumbar segmental instability: A narrative review - Medicine (Baltimore), 7;101(1), e28534 doi: 10.1097/MD.0000000000028534
Kneis S, Bruetsch V, Dalin D, Hubbe U, Maurer C. (2019): Altered postural timing and abnormally low use of proprioception in lumbar spinal stenosis pre- and post- surgical decompression - BMC Musculoskelet Disord., 1;20(1),183
Dunn AS, Baylis S, Ryan D. (2009): Chiropractic management of mechanical low back pain secondary to multiple-level lumbar spondylolysis with spondylolisthesis in a United States Marine Corps veteran: a case report - J Chiropr Med, 8(3),125–130
Birkmeyer NJ, Weinstein JN, Tosteson AN, et al. (2002): Design of the Spine patient outcomes research trial (SPORT)- Spine (Phila Pa 1976), 27(12),1361–1372
Matz PG, Meagher RJ, Lamer T, et al. (2016): Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis - Spine J,16(3), 439–448
Hendrickson NR, Kelly MP, Ghogawala Z, et al. (2018): Operative management of degenerative spondylolisthesis: a critical analysis review - JBJS Rev, 6(8), e4.
Wells GA, Shea B, O’Connell D, et al. (2001):The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in metaanalyses - Available at: http://www.ohri.ca/programs/clinical_ epidemiology/oxford.htm.
Van Tulder M, Furlan A, Bombardier C, Bouter LM, Deyo PA, Shekelle PG. (2003): Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group. Cochrane Library, Issue 4. Oxford: Update Software
Jose Alfredo Corredor, Fernando Flores de Araújo, Rodrigo Góes de Mendonça, et al. (2016): Nonoperative versus operative treatment of patients with degenerative spondylolisthesis - Coluna/Columna.,15(1), 33-35 http://dx.doi.org/10.1590/S1808-185120161501153514
James N. Weinstein, Jon D. Lurie,Tor D. Tosteson, Brett Hanscom, et al. (2007): Surgical versus Nonsurgical Treatment for Lumbar Degenerative Spondylolisthesis - N Engl J Med., 356 (22), 2257–2270 doi:10.1056/NEJMoa070302
James N. Weinstein, Jon D. Lurie,Tor D. Tosteson, Wenyan Zhaoet al. (2009):Surgical Compared with Nonoperative Treatment for Lumbar Degenerative Spondylolisthesis Four-Year Results in the Spine Patient Outcomes Research Trial (SPORT) Randomized and Observational Cohorts - J Bone Joint Surg Am., 91,1295-1304 doi:10.2106/JBJS.H.00913.
William A. Abdu, Olivia A. Sacks, Anna N.A. Tosteson, et al. (2018): Long-Term Results of Surgery Compared With Nonoperative Treatment for Lumbar Degenerative Spondylolisthesis in the Spine Patient Outcomes Research Trial (SPORT) – SPINE, 43(23), 1619–1630
Xu F, Tian Z, Fu C, Yao L, Yan M, Zou C, Liu Y, Wang Y. (2020): Mid-lumbar traumatic spondyloptosis without neurological deficit: A case report and literature review - Medicine (Baltimore), 99(12), e19578 doi: 10.1097/MD.0000000000019578
Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT. 1997 Volvo Award winner in clinical studies. (1997): Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation - Spine (Phila Pa 1976), 22(24), 2807-2812
Wei FL, Zhou CP, Liu R, et al. (2021): Management for lumbar spinal stenosis: A network meta-analysis and systematic review - Int J Surg., 85,19-28
Bridwell KH, Sedgewick TA, O’Brien MF, Lenke LG, Baldus C. (1993): The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis - J Spinal Disord, 6, 461–472
Herkowitz HN, Kurz LT. (1991): Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis - J Bone Joint Surg Am., 73, 802–808
Brox JI, Reikeras O, Nygaard O, et al. (2006): Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study – Pain,122 (1–2), 145–155
Brox JI, Sorensen R, Friis A, et al. (2003): Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration – Spine, 28(17),1913–1921
Fairbank J, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R. Spine Stabilization Trial Group. (2005): Randomized controlled trial to compare surgical stabilization of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilization trial – BMJ, 330(7502),1233.
Fritzell P, Hagg O, Wessberg P, Nordwall A. (2002): Swedish Lumbar Spine Study Group. Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish lumbar spine study group – Spine,27(11),1131–1141
Fritzell P, Hagg O, Wessberg P, Nordwall A. (2001): Swedish Lumbar Spine Study Group. 2001 Volvo Award Winner in Clinical Studies: lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group – Spine, 26(23), 2521–2532, discussion 2532–2534
Gaetani P, Aimar E, Panella L, et al. (2006): Functional disability after instrumented stabilization in lumbar degenerative spondylolisthesis: a follow-up study - Funct Neurol, 21, 31–37
Ghogawala Z, Benzel EC, Amin-Hanjani S, et al. (2004): Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative grade I spondylolisthesis - J Neurosurg Spine,1, 267–272
Kornblum MB, Fischgrund JS, Herkowitz HN, Abraham DA, Berkower DL, Ditkoff JS. (2004): Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion and pseudarthrosis – Spine,29, 726–733, discussion 733–734
Pratt RK, Fairbank JC, Virr A. (2002):The reliability of the Shuttle Walking Test, the Swiss Spinal Stenosis Questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the assessment of patients with lumbar spinal stenosis – Spine, 27, 84–91
Stucki G, Daltroy L, Liang MH, Lipson SJ, Fossel AH, Katz JN. (1996): Measurement properties of a self-administered outcome measure in lumbar spinal stenosis – Spine, 21, 796–803
Holmes C, Elder BD, Ishida W, Perdomo-Pantoja A, Locke J, Cottrill E, Lo SL, Witham TF. (2020): Comparing the efficacy of syngeneic iliac and femoral allografts with iliac crest autograft in a rat model of lumbar spinal fusion - J Orthop Surg Res., 15(1), 410
Jacobs WC, Rubinstein SM, Koes B, van Tulder MW, Peul WC. (2013): Evidence for surgery in degenerative lumbar spine disorders - Best Pract Res Clin Rheumatol. 27(5), 673-684
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