I'm starting to understand the idea of evidence-based medicine. What's the best evidence about spinal fusion for degenerative spondylolisthesis? I'm facing this problem myself right now.
There is a current review of surgical treatment for this problem. It was conducted by a group of researchers from the University of Ottawa in Canada. They searched the data banks and found a total of 1,923 studies. There were 66 studied that looked like possibilities.
After setting up what they were looking for (diagnosis, treatment, number of patients in the study, and so on), they were able to include 12 studies in the review. In these 12 studies, there was a total of almost 600 patients who had surgery for this condition.
Some patients had a decompression operation. Bone is removed to take pressure off the spinal nerve. In other studies, the surgeon did a decompression and then fused the spine. All the studies reported improvement in patient symptoms and function with the fusion except one.
The general trend in all these studies was for better results with fusion over decompression. Whether it's better to have a fusion with instrumentation (metal plates and/or screws) or just bone graft isn't clear yet.
Patients are more likely to get a solid fusion with instrumentation. But there's also a higher risk of repeat surgery needed following instrumented fusion. Best evidence supports fusion over decompression alone. But long-term patient results comparing different ways of doing the fusion have not been reported yet.
C. Ryan Martin, BSc, et al. The Surgical Management of Degenerative Lumbar Spondylolisthesis. In Spine. July 15, 2007. Vol. 32. No. 16. Pp. 1791-1798.
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