title: What is the optimum fusion technique for adult spondylolisthesis-PLIF or PLF or PLIF plus PLF? A meta-analysis from 17 comparative studies.
abstract: METHODS
  A meta-analysis and systemic review.
  
  
  OBJECTIVE
  To pool scientific evidence for the optimum selection in the treatment of lumbar spondylolisthesis by comparing the clinical effect of posterolateral fusion (PLF), posterior lumbar interbody fusion (PLIF), and PLIF plus PLF.
  
  
  BACKGROUND
  Clinical effect of the 3 fusion techniques has been reported in many studies. However, which is the best method is in dispute.
  
  
  METHODS
  A systematic search was conducted in MEDLINE, EMBASE, and the Cochrane Collaboration Library from January 1950 through May 2013. Comparative studies were performed according to eligibility criteria. Weighted mean differences and risk differences were calculated for common outcomes. The final strength of evidence was expressed as different level recommended by the Grading of Recommendations Assessment, Development, and Evaluation Working Group.
  
  
  RESULTS
  Four randomized controlled trials and 13 observational studies were eligible. PLIF was more effective than PLF in the improvement of clinical satisfaction (odds ratio [OR], 0.52; 95% confidence interval (CI), 0.31-0.89; P=0.02). No significant differences in the primary outcomes were seen between PLIF plus PLF and PLF (OR, 0.88; 95% CI, 0.47-1.64; P=0.69). For the complication rate, the differences were not significant between PLIF and PLF, and between PLIF plus PLF and PLF (OR, 2.27; 95% CI, 0.95-5.42; P=0.07; OR, 0.74; 95% CI, 0.22-2.44; P=0.62, respectively). In the secondary outcomes, PLIF was more effective than PLF in the improvement of fusion rate (P=0.0007) and reoperation rate (P=0.004). However, PLIF plus PLF failed to reveal more superiority than PLF (P>0.05).
  
  
  CONCLUSIONS
  PLIF plus PLF did not show more superiority than PLF alone. PLIF alone improved clinical satisfaction and decreased complication rate compared with PLF. PLIF maybe be better than the other 2 fusion methods in the treatment of lumbar spondylolisthesis. However, conclusions need to be treated with caution because of lack of high quality of evidence.
  
  
  METHODS
  1.
authors.affiliation: *Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China; and †Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
authors.forename: Xiao-Yang
authors.initials: XY
authors.lastname: Liu
authors.forename: Gui-Xing
authors.initials: GX
authors.lastname: Qiu
authors.forename: Xi-Sheng
authors.initials: XS
authors.lastname: Weng
authors.forename: Bin
authors.initials: B
authors.lastname: Yu
authors.forename: Yi-Peng
authors.initials: YP
authors.lastname: Wang
mesh_terms: D006801:Humans; D017116:Low Back Pain / Q000209:etiology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery*; D012086:Reoperation; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013168:Spondylolisthesis / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome