A Meta-Analysis of Circumferential Fusion Versus Instrumented Posterolateral Fusion in the Lumbar Spine

Study Design. A meta-analysis of circumferential fusion versus instrumented posterolateral fusion (PLF) in the lumbar spine. Objective. To compare the clinical efficacy of circumferential fusion and instrumented PLF and to collate the scientific evidence to find a useful fusion method. Summary of Background Data. Clinical results, advantages, and postoperative complications of circumferential fusion and instrumented PLF were shown in many studies. However, there are different opinions among surgeons concerning the preferred method for the 2 fusion methods. Methods. A highly sensitive search strategy was used to identify all published randomized controlled trials up to December 2007. A criteria list taken from Koes et al was used to evaluate the risk of bias of the included studies. The 5 questions that were recommended by the Cochrane Back Review Group were used to evaluate the clinical relevance. Cochrane methodology was used for the results of this meta-analysis. Results. Four randomized controlled trials of surgery for lumbar degenerative disease were identified. No significant difference was found in the primary beneficial clinical outcome (odds ratios[OR]: 0.96, 95% confidence limits[95% CI]: [0.59, 1.55], [P = 0.87]). Significant difference was found in the complication rate (OR: 1.89, 95% CI: [1.14, 3.14], [P = 0.01]), which reflects the primary harm outcome. In the secondary outcomes, significant differences were found between circumferential fusion and instrumented PLF in the fusion rate (OR: 2.11, 95% CI: [1.06, 4.19], [P = 0.03]), the reoperation rate (OR: 0.44, 95% CI: [0.25, 0.77], [P = 0.004]), and the amount of blood loss (WMD = 349.95, 95% CI: [138.26, 561.64], [P = 0.001]). No significant difference was found the operating time (WMD = 90.24, 95% CI: [-9.71, 190.20], [P = 0.08]). Conclusion. Compared with instrumented PLF, circumferential fusion can increase the fusion rate and reduce the reoperation rate, but it can also increase the complication rate and the amount of blood loss. No significant difference was found in the global assessment of clinical outcome about the 2 fusion procedures.