The scores ranged from 18 to 20 with a median value. The summary of outcomes of included studies was shown in Table. Table 1: The characteristics of the included studies. Table 2: quality assessment of five included studies. Table 3: The summary of outcomes of included studies. Perioperative parameters All five studies reported the operative time data of both groups; the meta-analysis showed that the mi group essay had a significantly longer operative time than op group, with smd.36 (95 CI:.08,.64). Four studies reported the data of estimated blood loss; the meta-analysis showed that the mi group had a significantly less blood loss than the op group, with smd.42 (95 CI:.64,.20).
Finally, five nonrandom prospective comparative studies were included in you this meta-analysis. The procedure of literatures selection was showed in Figure 1 (prisma flow diagram). Characteristics and qualifications of Included Studies The characteristics of all five included studies were summarized and shown in Table. All the five included studies were prospective comparative studies without random. They were from five different countries (Australia, china, germany, japan, and usa) and all of them were published after 2010. Total of 184 participants in mi group and 182 in op group were included in this meta-analysis. The methodological quality assessment of the five included studies was summarized in Table.
Relative risk (RR) was calculated for dichotomous outcomes such as complications, nonfusion, and secondary surgery. Standard mean difference (SMD) was calculated for continuous outcomes such as operative time, estimated blood loss, length of hospital stay, and clinical parameters. Heterogeneity was assessed using the and. We defined the acceptable heterogeneity by value of test.10 and. For heterogeneity data, sensitivity analysis was involved to remove one study and evaluate whether the other results would be markedly affected. Included Studies A total 1926 potential records were identified through Medline embase and Cochrane library. The list of articles were input into software endnote X4, and then 243 duplicate articles were excluded, after titles and abstracts screened, leaving 21 full-text articles to be assessed for eligibility, and 16 were excluded for reasons of the papers were review or retrospective studies.
min — instability of the spine, spinal displacement
Two authors (Zhen-hua book feng and Wan-Qing Weng) independently assessed the potentially eligible studies. Firstly, the titles and abstracts were screened to exclude the duplicated and apparently irrelevant ones or those that do not meet our inclusion criteria. After then, the remaining potential studies were full-text downloaded and reviewed. Any disagreement between two above authors was sent and discussed with the third independent author (ai-min Wu). Data Extraction Two reviewers (Chun-hui chen and Shu-min Li) independently extracted data, and the third reviewer (Wen-fei ni) checked the consistency between them. A standard form was used; the extracted items included the following: the general study information, for example, the authors, publishing date, country, name of investigate site, study design, sample size, age, gender, index levels, follow-up term; perioperative parameters, including operative time, estimated blood loss, x-ray. For continuous outcomes, we extracted the mean and sd (standard deviation) and participant number will be sheets extracted.
For dichotomous outcomes, we extracted the total numbers and the numbers of events of both groups. The data in other forms was recalculated when possible to enable pooled analysis. Quality Assessment of Included Studies The methodological index for nonrandomized studies (minors) was used to assess the quality of the included studies 22,. Twelve items were scored as 0 (not reported 1 (reported but inadequate or 2 (reported and adequate). Two reviewers (ai-min wu and Yong-Long Chi) independently assessed the quality of the included studies. Statistical Analysis The data was collected and input into the stata software (version.0; StataCorp, college Station, tx) for meta-analysis. Random-effects model was used to combine the data from individual studies.
The difference of spondylolisthesis to other degenerative lumbar diseases (such as lumbar stenosis without spondylolisthesis and lumbar disc herniated) is that in spondylolisthesis patients the vertebrae will be slipped anteriorly. The traditional open spinal fusion, which performed laminectomy to completely decompression the spinal canal and nerve root, was recognized as one of the gold standard methods in treatment of spondylolisthesis and had credible pain relief and function improvement 19,. Mi technique may be hard to achieve completely decompression because of the limited vision; therefore, the clinical efficacy and safety of minimally invasive posterior spinal fusion in treatment of lumbar spondylolisthesis are still controversial. In this study, we aim to provide the best evidence from current prospective comparative studies for surgeons and researchers. Methods This systematic review and meta-analysis was done according to the preferred reporting items for systematic review and meta-analyses (prisma) guidelines (Checklist S1 in Supplementary material available online at ).
No primary personal data will be collected; therefore no additional ethical approval needs to be obtained. Search Strategy Two authors (Chun-hui chen and Zhi-hao shen) independently searched the electronic literature database of Pubmed, Embase, and Cochrane library, without language limitation at April 2016. The key words were used as follows: posterior lumbar interbody fusion, transforaminal lumbar interbody fusion, posterolateral lumbar fusion, posterior lumbar fusion, posterior lumbar arthrodesis, minimally invasive lumbar fusion, minimally invasive fusion, spondylolisthesis, isthmic spondylolisthesis, and degenerative spondylolisthesis. One of search strategy developed with comprehensive use of keywords performed in Pubmed was showed in Table. Related articles and reference lists were searched to avoid original miss. Eligibility Criteria the study was included in this meta-analysis if it was prospective randomized controlled trial (RCT) or nonrandomized prospective comparative study; it compared the clinical outcomes of minimally invasive posterior approach lumbar fusion versus traditional open posterior approach lumbar fusion; the participants were spondylolisthesis. Exclusion criteria were as follows: respective studies, case series, case report, and review articles; follow-up of less than 12 months; duplicated publications from the same hospital or research center. Selection of Literature we used the prisma flow diagram to select the included studies (Figure 1 the results of literature search were imported into the software Endnote.
Spondylolisthesis - presentation and, treatment, bone
Introduction, with the help of radiographic and endoscopic system and special surgical tools, the minimally invasive posterior lumbar surgery was developed and worldwide popularly in last decades 1,. It was reported the minimally invasive spinal surgery techniques had advantages of shorter skin wound incision, less muscle trauma, less blood loss, and hospital stay. Currently, the minimally invasive (MI) lumbar spinal fusion techniques including mi posterior lumbar interbody fusion 6, mi transforaminal lumbar interbody fusion 7, 8, mi posterolateral lumbar fusion, mi lateral lumbar fusion 9, mi oblique lumbar interbody fusion, and mi anterior lumbar interbody fusion. The posterior approach permits the decompression and discectomy directly and does not have complications of vessel, hypogastric sympathetic plexus, and ureter injury, which may be caused by anterior approach 10 12, and is most widely used nowadays. And the previous systematic review and meta-analysis in literatures showed that mi transforaminal lumbar interbody fusion appears similar safety and efficacy to open transforaminal lumbar interbody fusion and associated with lower blood loss and infection rates for general degenerative lumbar disease patient hippie 14,. However, spondylolisthesis is one of the most lumbar spinal disorders and may be caused by isthmic or degeneration. The symptoms of spondylolisthesis include low back pain and leg pain, decreasing walk ability, and neurogenic claudication. Surgical interventions were recommended when the symptoms could not be relieved by conservative treatment.
Creative commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. To investigate the evidence of minimally invasive (MI) versus open (OP) posterior lumbar fusion in treatment of lumbar spondylolisthesis from current prospective literatures. The electronic literature database of Pubmed, Embase, and Cochrane library was searched at April 2016. The data of operative time, estimated blood loss and length of hospital stay, visual analog scale (VAS) of both lower back pain and leg pain, Oswestry disability index (odi sf-36 pcs homelessness (physical component scores) and sf-36 mcs (mental component scores complications, fusion rate, and secondary. Five nonrandom prospective comparative studies were included in this meta-analysis. The meta-analysis showed that the mi group had a significantly longer operative time than op group, less blood loss, and shorter hospital stay. No significant difference was found in back pain, leg pain, odi, sf-36 pcs, sf-36 mcs, complications, fusion rate, and secondary surgery between mi and op groups. The prospective evidence suggested that mi posterior fusion for spondylolisthesis had less ebl and hospital stay than op fusion; however it took more operative time. Both mi and op fusion had similar results in pain and functional outcomes, complication, fusion rate, and secondary surgery.
non-surgical treatment is successful in relieving the patients pain, but if not surgery may be considered. Spinal fusion surgery for spondylolisthesis is generally quite effective, but because it is a large procedure with a lot of recovery, it usually is not considered until a patient has failed to find pain relief with at least six months focused on a range. A posterior fusion with pedicle screw instrumentation is generally considered the gold standard form of lumbar spinal fusion. The surgeon may also recommend a spinal fusion done from the front of the spine at the same time. The type of spinal fusion that is recommended by a surgeon is based largely on a surgeons preference and experience, as well as the patients clinical situation. Spinal Fusion Surgery for Isthmic Spondylolisthesis. 1Department of Orthopedics, second Affiliated Hospital of Wenzhou medical University, second Medical College of Wenzhou medical University, zhejiang Spine center, wenzhou, zhejiang, China 2Department of Orthopedics, hainan Medical College, haikou, hainan, China 3Laboratory of Internal Medicine, the first Affiliated Hospital of Wenzhou medical University, wenzhou. Copyright 2017 ai-min wu. This is an open access article distributed under the.
The exercise program should be controlled and gradually increase over help time. Exercise for Sciatica from Isthmic Spondylolisthesis. Manual manipulation, chiropractic manipulation, or manual manipulation from osteopathic doctors, physiatrists or other appropriately trained health professionals, can help reduce pain by mobilizing painful joint dysfunction. Article continues below, epidural steroid Injections, if the patient is having severe pain, injections can be useful. Epidural injections can help decrease inflammation in the area. The pars fracture itself can be injected with lidocaine and steroids for a diagnostic study. If the patients pain is relieved after a lidocaine injection it can be assumed that the pars fracture is the source of the patients pain.
Journal of Medical Case reports Abstract
Non-surgical treatment for adult patients with an isthmic spondylolisthesis is similar to that for patients with low back pain and/or leg pain from other conditions and may include one or a combination of: Medications, pain medications, such as acetaminophen, and/or nsaids (e.g. Ibuprofen, cox-2 inhibitors) or oral hippie steroids to reduce inflammation in the area. Heat and/or ice application, heat and/or ice application, to reduce localized pain. Generally, ice is recommended to relieve pain or discomfort directly after an activity that has caused the pain. Heat application is recommended to relax the muscles, and promote blood flow and a healing environment. Heat and Cold Therapy Information Center. Physical Therapy, stretching is recommended, beginning with hamstring stretching and progressing over time. In addition, special attention should be paid to stretching the hamstrings twice daily in order to alleviate stress on the low back.