title: Evidence-based medicine analysis of isthmic spondylolisthesis treatment including reduction versus fusion in situ for high-grade slips.
abstract: METHODS
  : Literature review.
  
  
  OBJECTIVE
  : 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.
  
  
  BACKGROUND
  : 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.
  
  
  CONCLUSIONS
  : 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.
authors.affiliation: Twin Cities Spine Center, Minneapolis, MN, USA.
authors.forename: Ensor E
authors.initials: EE
authors.lastname: Transfeldt
authors.forename: Amir A
authors.initials: AA
authors.lastname: Mehbod
mesh_terms: D001863:Bone Screws; D002648:Child; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013168:Spondylolisthesis / Q000453:epidemiology / Q000601:surgery*