Sarcouncil Journal of Internal Medicine and Public Health

Abstract: Background and Objectives: The goal of this systematic review is to pool the evidence comparing the surgical outcomes of fusion versus non-fusion, including decompression alone and decompression with instrumentation, in the treatment of lumbar spondylolisthesis. The aim was to assess long-term clinical, functional, and radiological results, and to assess the potential for non-fusion surgery to be considered as an alternative to conventional fusion technique in low-grade and degenerative cases. Inclusion and Exclusion Criteria: Studies included were randomized controlled trials, prospective or retrospective cohort studies, systematic reviews, and reported outcomes related to pain, disability, or stability of the spine in adult patients with lumbar spondylolisthesis that were treated with surgery (fusion, non-fusion, or decompression). Exclusion criteria involved non-English publications, pediatric cases, non-surgical management, high-grade spondylolisthesis (>Grade II), and studies without comparator arms or a long follow-up period exceeding one year. Methods Summary: The seven key studies identified from the literature search targeted the databases PubMed and other relevant journals. The following data were obtained to evaluate the study design, patient characteristics, outcome measures (e.g., VAS for pain, ODI for disability), and follow-up periods. Given the heterogeneity, narrative synthesis was used, and quality appraisal using GRADE criteria to weight the evidence. Conclusion: Both fusion and non-fusion surgeries were shown to have similar outcomes in terms of pain relief and functional status for different types of spondylolisthesis and were effective in the long term. Decompression was superior to fusion in disability reduction in degenerative low-grade cases, but was similar to fusion in reducing reoperation, and deterioration of back pain, especially in isthmic spondylolisthesis. Percutaneous stabilization did not increase morbidity, but rather was as effective at improving radiological alignment as fusion, and had similar clinical benefits in elderly patients. Baseline factors and the procedure type were associated with risks of deterioration and, therefore, the need for customized selection. Conclusions: Non-fusion decompression is a good alternative to fusion for stable low-grade lumbar spondylolisthesis, providing equivalent pain and function improvement, and with a potentially lower rate of complications.