Evidence-based medicine analysis of isthmic spondylolisthesis treatment including reduction versus fusion in situ for high-grade slips

Abstract

Study design: : Literature review.

Objectives: : The purpose of this article is to review the available literature and to attempt to formulate evidence-based recommendations for the surgical treatment of high-grade spondylolisthesis in the pediatric population.

Summary of background data: : The surgical management of high-grade spondylolisthesis remains controversial due to the lack of high level evidence. Prospective randomized studies have not been completed.

Methods: : Through an electronic database search and published literature cross-reference, appropriate studies were identified and assigned the appropriate level of evidence.

Results: : There were no Level I or II evidence on this topic with our search. The best level of evidence that we have on this topic is retrospective comparative studies. We found 5 such articles which compared fusion in situ to reduction and fusion for high-grade spondylolisthesis. Pseudarthrosis rates are decreased by performing an instrumented reduction with a fusion. However, there is no significant difference in a clinical outcome of patients treated in situ versus reduction.

Conclusion: : Because of the paucity of high levels of evidence, we are not able to formulate clear guidelines for treatment of high-grade spondylolisthesis based on the best evidence available in the published literature.