• Radek Kaiser, Lucia Kantorová, Alena Langaufová, Simona Slezáková, Dagmar Tučková, Miloslav Klugar, Zdeněk Klézl, Pavel Barsa, Jan Cienciala, Richard Hajdúk, Lumír Hrabálek, Roman Kučera, David Netuka, Martin Prýmek, Martin Repko, Martin Smrčka, and Jan Štulík.
• Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University, Prague, Czech Republic Radek.Kaiser@uvn.cz.
• J. Neurol. Neurosurg. Psychiatr. 2023 Aug 1; 94 (8): 657666657-666.

ObjectiveTo determine the efficacy of adding instrumented spinal fusion to decompression to treat degenerative spondylolisthesis (DS).DesignSystematic review with meta-analysis.Data SourcesMEDLINE, Embase, Emcare, Cochrane Library, CINAHL, Scopus, ProQuest Dissertations & Theses Global, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform from inception to May 2022.Eligibility Criteria For Study SelectionRandomised controlled trials (RCTs) comparing decompression with instrumented fusion to decompression alone in patients with DS. Two reviewers independently screened the studies, assessed the risk of bias and extracted data. We provide the Grading of Recommendations, Assessment, Development and Evaluation assessment of the certainty of evidence (COE).ResultsWe identified 4514 records and included four trials with 523 participants. At a 2-year follow-up, adding fusion to decompression likely results in trivial difference in the Oswestry Disability Index (range 0-100, with higher values indicating greater impairment) with mean difference (MD) 0.86 (95% CI -4.53 to 6.26; moderate COE). Similar results were observed for back and leg pain measured on a scale of 0 to 100, with higher values indicating more severe pain. There was a slightly increased improvement in back pain (2-year follow-up) in the group without fusion shown by MD -5·92 points (95% CI -11.00 to -0.84; moderate COE). There was a trivial difference in leg pain between the groups, slightly favouring the one without fusion, with MD -1.25 points (95% CI -6.71 to 4.21; moderate COE). Our findings at 2-year follow-up suggest that omitting fusion may increase the reoperation rate slightly (OR 1.23; 0.70 to 2.17; low COE).ConclusionsEvidence suggests no benefits of adding instrumented fusion to decompression for treating DS. Isolated decompression seems sufficient for most patients. Further RCTs assessing spondylolisthesis stability are needed to determine which patients would benefit from fusion.Prospero Registration NumberCRD42022308267.© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.

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