title: Techniques of lumbar-sacral spine fusion in spondylosis: systematic literature review and meta-analysis of randomized clinical trials.
abstract: BACKGROUND
  Spine fusions can be performed through different techniques and are used to treat a number of vertebral pathologies. However, there seems to be no consensus regarding which technique of fusion is best suited to treat each distinct spinal disease or group of diseases.
  
  
  OBJECTIVE
  To study the effectiveness and complications of the different techniques used for spinal fusion in patients with lumbar spondylosis.
  
  
  METHODS
  Systematic literature review and meta-analysis.
  
  
  METHODS
  Randomized clinical studies comparing the most commonly performed surgical techniques for spine fusion in lumbar-sacral spondylosis, as well as those reporting patient outcome were selected.
  
  
  METHODS
  Identify which technique, if any, presents the best clinical, functional, and radiographic outcome.
  
  
  METHODS
  Systematic literature review and meta-analysis based on scientific articles published and indexed to the following databases: PubMed (1966-2009), Cochrane Collaboration-CENTRAL, EMBASE (1980-2009), and LILACS (1982-2009). The general search strategy focused on the surgical treatment of patients with lumbar-sacral spondylosis.
  
  
  RESULTS
  Eight studies met the inclusion criteria and were selected with a total of 1,136 patients. Meta-analysis showed that patients who underwent interbody fusion presented a significantly smaller blood loss (p=.001) and a greater rate of bone fusion (p=.02). Patients submitted to fusion using the posterolateral approach had a significantly shorter operative time (p=.007) and less perioperative complications (p=.03). No statistically significant difference was found for the other studied variables (pain, functional impairment, and return to work).
  
  
  CONCLUSIONS
  The most commonly used techniques for lumbar spine fusion in patients with spondylosis were interbody fusion and posterolateral approach. Both techniques were comparable in final outcome, but the former presented better rates of fusion and the latter the less complications.
authors.affiliation: Spine Surgery Group, Orthopedics Department, Santa Casa School of Medicine and Hospitals, São Paulo, Rua Cesário Mota Junior 112 Vila Buarque, São Paulo 01221-020, Brazil. ricardoumeta@gmail.com
authors.forename: Ricardo S G
authors.initials: RS
authors.lastname: Umeta
authors.forename: Osmar
authors.initials: O
authors.lastname: Avanzi
mesh_terms: D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D016032:Randomized Controlled Trials as Topic; D012447:Sacrum / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D055009:Spondylosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome