Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 1;35(5):213-221.
doi: 10.1097/BSD.0000000000001266. Epub 2021 Oct 22.

Instrumented Versus Noninstrumented Spinal Fusion for Degenerative Lumbar Spondylolisthesis: A Systematic Review

Takashi Hirase  1   2 , Jeremiah F Ling  2 , Varan Haghshenas  1 , Bradley K Weiner  1
Affiliations

Instrumented Versus Noninstrumented Spinal Fusion for Degenerative Lumbar Spondylolisthesis: A Systematic Review

Takashi Hirase et al. Clin Spine Surg. .

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.

PubMed Disclaimer

Conflict of interest statement

B.K.W. has the following disclosures: AAOS: Committee member; AOA: Committee member; The Spine Journal: Editorial Board; Department of Defense Grants. The remaining authors declare no conflict of interest.

References

    1. Bydon M, Alvi MA, Goyal A. Degenerative lumbar spondylolisthesis: definition, natural history, conservative management, and surgical treatment. Neurosurg Clin N Am. 2019;30:299–304.
    1. Kalichman L, Hunter DJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17:327–335.
    1. Steiger F, Becker HJ, Standaert CJ, et al. Surgery in lumbar degenerative spondylolisthesis: indications, outcomes and complications. A systematic review. Eur Spine J. 2014;23:945–973.
    1. Ilyas H, Udo-Inyang I Jr, Savage J. Lumbar spinal stenosis and degenerative spondylolisthesis: a review of the SPORT literature. Clin Spine Sur. 2019;32:272–278.
    1. Chan AK, Sharma V, Robinson LC, et al. Summary of guidelines for the treatment of lumbar spondylolisthesis. Neurosurg Clin N Am. 2019;30:353–364.

Publication types

LinkOut - more resources