A comprehensive comparison of posterior lumbar interbody fusion versus posterolateral fusion for the treatment of isthmic and degenerative spondylolisthesis: A meta-analysis of prospective studies.

Posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) are both frequently-used procedures for the surgical treatment of isthmic and degenerative spondylolisthesis. The current meta-analysis aimed to perform a comprehensive comparison between PLF and PLIF in terms of the therapeutic effects on spondylolisthesis. PubMed, Embase, Web of Science and the Cochrane Central Register of Controlled Trials were searched for relevant prospective studies. Measures of clinical outcome, postoperative complication rate, fusion rate, and blood loss are presented as odds ratio (OR), mean difference and corresponding 95 % confidence interval (CI) as appropriate. Eight prospective studies comprising 723 patients were eventually enrolled in the meta-analysis. Patients who underwent PLIF had a better clinical outcome (pooled OR, 1.63 [95 % CI, 1.02-2.61]; p = 0.04) and a higher fusion rate (pooled OR, 3.33 [95 % CI, 1.88-5.90]; p < 0.01) than those who underwent PLF. No significant difference between the two procedures was identified for postoperative complication rate and blood loss. The results showed that PLIF was superior to PLF in clinical outcome and fusion rate, and equal to PLF in terms of blood loss and the rate of postoperative complications. Here we provide the most effective evidence currently available for the comparison between PLF and PLIF, which has guiding significance for clinical practice.