Abstract：
OBJECTIVE: To compare the clinical effectiveness of reduction and fusion with in situ fusion in the management of patients with degenerative lumbar spondylolisthesis (DLS).
METHODS: The systematic review was conducted following the PRISMA guidelines. Relevant studies were identified from PubMed, Embase, Scopus, Cochrane Library, ClinicalTrials.gov, and Google Scholar. The inclusion criteria were: (1) comparative studies of reduction and fusion versus in situ fusion for DLS patients, (2) outcomes reported as VAS/NRS, ODI, JOA score, operating time, blood loss, complication rate, fusion rate, or reoperation rate, (3) randomized controlled trials and observational studies published in English from the inception of the databases to January 2023. The exclusion criteria included: (1) reviews, case series, case reports, letters, and conference reports, (2) in vitro biomechanical studies and computational modeling studies, (3) no report on study outcomes. The risk of bias 2 (RoB2) tool and the Newcastle-Ottawa scale was conducted to assess the risk of bias of RCTs and observational studies, respectively.
RESULTS: Five studies with a total of 704 patients were included (375 reduction and fusion, 329 in situ fusion). Operating time was significantly longer in the reduction and fusion group compared to in situ fusion group (weighted mean difference 7.20; 95% confidence interval 0.19, 14.21; P = 0.04). No additional significant intergroup differences were noted in terms of other outcomes analyzed.
CONCLUSIONS: While the reduction and fusion group demonstrated a statistically longer operating time compared to the in situ fusion group, the clinical significance of this difference was minimal. The findings suggest no substantial superiority of lumbar fusion with reduction over without reduction for the management of DLS.
METHODS: The systematic review was conducted following the PRISMA guidelines. Relevant studies were identified from PubMed, Embase, Scopus, Cochrane Library, ClinicalTrials.gov, and Google Scholar. The inclusion criteria were: (1) comparative studies of reduction and fusion versus in situ fusion for DLS patients, (2) outcomes reported as VAS/NRS, ODI, JOA score, operating time, blood loss, complication rate, fusion rate, or reoperation rate, (3) randomized controlled trials and observational studies published in English from the inception of the databases to January 2023. The exclusion criteria included: (1) reviews, case series, case reports, letters, and conference reports, (2) in vitro biomechanical studies and computational modeling studies, (3) no report on study outcomes. The risk of bias 2 (RoB2) tool and the Newcastle-Ottawa scale was conducted to assess the risk of bias of RCTs and observational studies, respectively.
RESULTS: Five studies with a total of 704 patients were included (375 reduction and fusion, 329 in situ fusion). Operating time was significantly longer in the reduction and fusion group compared to in situ fusion group (weighted mean difference 7.20; 95% confidence interval 0.19, 14.21; P = 0.04). No additional significant intergroup differences were noted in terms of other outcomes analyzed.
CONCLUSIONS: While the reduction and fusion group demonstrated a statistically longer operating time compared to the in situ fusion group, the clinical significance of this difference was minimal. The findings suggest no substantial superiority of lumbar fusion with reduction over without reduction for the management of DLS.
摘要：
目的：比较复位融合与原位融合治疗退行性腰椎滑脱症（DLS）的临床疗效。
方法：系统评价是按照PRISMA指南进行的。相关研究来自PubMed，Embase,Scopus,科克伦图书馆,ClinicalTrials.gov,谷歌学者。纳入标准为：（1）DLS患者的复位和融合与原位融合的比较研究，(2)结果报告为VAS/NRS，ODI,JOA得分,操作时间,失血,并发症发生率,融合率,或再手术率，（3）从数据库开始到2023年1月以英文发表的随机对照试验和观察性研究。排除标准包括：(1)审查，案例系列,病例报告,信件,和会议报告，(2)体外生物力学研究和计算建模研究,(3)无研究结果报告。偏倚风险2（RoB2）工具和纽卡斯尔-渥太华量表进行评估RCT和观察性研究的偏倚风险，分别。
结果：共纳入5项研究，共704名患者（375个复位和融合，329原位融合)。与原位融合组相比，复位和融合组的手术时间明显更长（加权平均差7.20；95％置信区间0.19，14.21；P=0.04）。在分析的其他结果方面，没有发现其他显著的组间差异。
结论：与原位融合组相比，复位和融合组的手术时间在统计学上更长，这种差异的临床意义很小.研究结果表明，对于DLS的治疗，减少腰椎融合没有明显的优势。
方法：系统评价是按照PRISMA指南进行的。相关研究来自PubMed，Embase,Scopus,科克伦图书馆,ClinicalTrials.gov,谷歌学者。纳入标准为：（1）DLS患者的复位和融合与原位融合的比较研究，(2)结果报告为VAS/NRS，ODI,JOA得分,操作时间,失血,并发症发生率,融合率,或再手术率，（3）从数据库开始到2023年1月以英文发表的随机对照试验和观察性研究。排除标准包括：(1)审查，案例系列,病例报告,信件,和会议报告，(2)体外生物力学研究和计算建模研究,(3)无研究结果报告。偏倚风险2（RoB2）工具和纽卡斯尔-渥太华量表进行评估RCT和观察性研究的偏倚风险，分别。
结果：共纳入5项研究，共704名患者（375个复位和融合，329原位融合)。与原位融合组相比，复位和融合组的手术时间明显更长（加权平均差7.20；95％置信区间0.19，14.21；P=0.04）。在分析的其他结果方面，没有发现其他显著的组间差异。
结论：与原位融合组相比，复位和融合组的手术时间在统计学上更长，这种差异的临床意义很小.研究结果表明，对于DLS的治疗，减少腰椎融合没有明显的优势。
