Surgical management of high-grade paediatric spondylolisthesis: meta-analysis and systematic review,European Spine Journal

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Surgical management of high-grade paediatric spondylolisthesis: meta-analysis and systematic review
European Spine Journal ( IF 2.6 ) Pub Date : 2022-10-05 , DOI: 10.1007/s00586-022-07408-3
Robert Koucheki _{1,

2} , Brett Rocos _{3,

4} , Rajiv Gandhi _{1,

4} , Stephen J Lewis _{1,

3} , David E Lebel _{1,

3}

Affiliation

Purpose

There is currently no consensus on the management of high-grade spondylolisthesis (HGS) in paediatric populations. The objective of this analysis is to compare the outcomes of reduction followed by fusion (RFF) or in situ fusion (ISF) in paediatric patients.

Methods

Using major databases, a systematic literature search was performed. Primary studies comparing ISF with RFF in paediatric and adolescent patients were identified. Study data including patient-reported outcomes, complications, and spinopelvic parameters were collected and analysed.

Results

Seven studies were included, comprising 97 ISF and 131 RFF. Average patient age was 14.4 ± 2.1 years and follow up was 8.2 ± 5.1 years. Patients undergoing RFF compared to patients undergoing ISF alone were less likely to develop pseudarthrosis (RR 0.51, 95% CI, [0.26, 0.99], p = 0.05). On average, RFF led to 11.97º more reduction in slip angle and 34.8% more reduction in sagittal translation (p < 0.00001) compared to ISF. There was no significant difference between patient satisfaction and pain at follow up. Neurologic complications and reoperation rates were not significantly different.

Conclusions

Both RFF and ISF are effective techniques for managing HGS. Performing a reduction followed by fusion reduces the likelihood of pseudarthrosis in paediatric patients. The difference between risk of neurologic complications, need for reoperation, patient satisfaction, and pain outcomes did not reach statistical significance. Correlation with patient-reported outcomes still needs to be further explored.

Level 3 evidence

Meta-analysis of Level 3 studies.

中文翻译：

重度儿童脊椎滑脱的手术治疗：荟萃分析和系统评价

目的

目前对于儿科人群重度脊椎滑脱 (HGS) 的管理尚无共识。该分析的目的是比较儿科患者先复位后融合 (RFF) 或原位融合 (ISF) 的结果。

方法

使用主要数据库，进行了系统的文献检索。确定了在儿科和青少年患者中比较 ISF 与 RFF 的初步研究。收集和分析了研究数据，包括患者报告的结果、并发症和脊柱骨盆参数。

结果

纳入了七项研究，包括 97 项 ISF 和 131 项 RFF。患者平均年龄为 14.4 ± 2.1 岁，随访时间为 8.2 ± 5.1 岁。与单独接受 ISF 的患者相比，接受 RFF 的患者发生假关节的可能性较小 (RR 0.51, 95% CI, [0.26, 0.99], p = 0.05)。平均而言，与 ISF 相比，RFF 导致侧偏角减少 11.97º，矢状平移减少 34.8% ( p < 0.00001)。随访时患者满意度和疼痛无显着差异。神经系统并发症和再手术率没有显着差异。