{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:07:22Z","timestamp":1772827642467,"version":"3.50.1"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,3]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Isthmic spondylolisthesis impacts up to 11.5% of the general population. For patients who have failed conservative therapy, decompression and fusion or decompression alone are options for surgical management. However, there remains debate as to whether reduction of mobile spondylolisthesis is integral to good patient outcomes. The present systematic review and meta-analysis aimed to address this by comparing clinical and radiological outcomes between patients treated with fusion in situ and those undergoing fusion with reduction of isthmic spondylolisthesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The Scopus, EMBASE, Medline, and Cochrane databases were systematically queried on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies comparing treatment outcomes in patients with isthmic spondylolisthesis after in situ fusion or fusion with spondylolisthesis reduction. Endpoints of interest included Oswestry Disability Index (ODI) score, hospitalization duration, operative morbidity, and rates of surgical revision. Data from individual studies were aggregated using random-effects models to assess combined effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of 277 identified studies, 7 studies were included with an aggregate 308 patients (143 underwent fusion in situ and 165 underwent reduction). Patients who underwent reduction for isthmic lumbar spondylolisthesis had significantly lower rates of pseudarthrosis at last follow-up (OR 0.22, p = 0.03). Estimated blood loss, operative time, hospitalization duration, change in ODI score, change in back pain (visual analog scale [VAS]), and reoperation rate did not differ significantly between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>For patients with isthmic spondylolisthesis, the present data suggest that fusion with reduction of spondylolisthesis may lower rates of pseudarthrosis as compared to in situ fusion. However, operative morbidity and improvement in patient-reported outcomes were similar between strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.4.spine241213","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T20:53:24Z","timestamp":1763412804000},"page":"62-71","source":"Crossref","is-referenced-by-count":0,"title":["Reduction versus fusion in situ for isthmic spondylolisthesis: a systematic review and meta-analysis"],"prefix":"10.3171","volume":"44","author":[{"given":"Sarah E.","family":"Johnson","sequence":"first","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Nguyen","sequence":"additional","affiliation":[{"name":"John A. Burns School of Medicine, University of Hawai\u2019i at M\u0101noa, Hawaii;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karthik","family":"Papisetty","sequence":"additional","affiliation":[{"name":"University of Minnesota Medical School, Minneapolis, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahani","family":"Aljanaahi","sequence":"additional","affiliation":[{"name":"College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zach","family":"Pennington","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgos","family":"Michalopoulos","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karim Rizwan","family":"Nathani","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sufyan","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantinos","family":"Katsos","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamad","family":"Bydon","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Spine (Phila Pa 1976)","first-page":"199","article-title":"Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population","volume":"34","author":"Kalichman L","year":"2009","unstructured":"Kalichman L, Kim DH, Li L, Guermazi A, Berkin V, Hunter DJ. Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976). 2009;34(2):199\u2013205."},{"issue":"117","key":"b2","series-title":"Clin Orthop Relat Res","first-page":"23","article-title":"Classification of spondylolisis and spondylolisthesis","volume":"117","author":"Wiltse LL","year":"1976","unstructured":"Wiltse LL, Newman PH, Macnab I. Classification of spondylolisis and spondylolisthesis. Clin Orthop Relat Res. 1976;117(117):23\u201329."},{"issue":"4","key":"b3","series-title":"Eur Spine J","first-page":"391","article-title":"Fusion for low-grade adult isthmic spondylolisthesis: a systematic review of the literature","volume":"15","author":"Jacobs WC","year":"2006","unstructured":"Jacobs WC, Vreeling A, De Kleuver M. Fusion for low-grade adult isthmic spondylolisthesis: a systematic review of the literature. Eur Spine J. 2006;15(4):391\u2013402."},{"issue":"6","key":"b4","series-title":"J Am Board Fam Med","first-page":"1204","article-title":"Spondylolysis and isthmic spondylolisthesis: a guide to diagnosis and management","volume":"35","author":"Mohile NV","year":"2022","unstructured":"Mohile NV, Kuczmarski AS, Lee D, Warburton C, Rakoczy K, Butler AJ. Spondylolysis and isthmic spondylolisthesis: a guide to diagnosis and management. J Am Board Fam Med. 2022;35(6):1204\u20131216."},{"issue":"3","key":"b5","series-title":"Neurosurg Clin N Am","first-page":"283","article-title":"Isthmic lumbar spondylolisthesis","volume":"30","author":"Bhalla A","year":"2019","unstructured":"Bhalla A, Bono CM. Isthmic lumbar spondylolisthesis. Neurosurg Clin N Am. 2019;30(3):283\u2013290."},{"issue":"1","key":"b6","series-title":"Spine J","first-page":"36","article-title":"The long-term effect of posterolateral fusion in adult isthmic spondylolisthesis: a randomized controlled study","volume":"5","author":"Ekman P","year":"2005","unstructured":"Ekman P, M\u00f6ller H, Hedlund R. The long-term effect of posterolateral fusion in adult isthmic spondylolisthesis: a randomized controlled study. Spine J. 2005;5(1):36\u201344."},{"issue":"6","key":"b7","series-title":"Biosci Rep","first-page":"BSR20192888","article-title":"Fusion in situ versus reduction for spondylolisthesis treatment: grading the evidence through a meta-analysis","volume":"40","author":"He R","year":"2020","unstructured":"He R, Tang GL, Chen K, Luo ZL, Shang X. Fusion in situ versus reduction for spondylolisthesis treatment: grading the evidence through a meta-analysis. Biosci Rep. 2020;40(6):BSR20192888."},{"issue":"8","key":"b8","series-title":"Ann Palliat Med","first-page":"8523","article-title":"Is reduction or arthrodesis in situ the optimal choice for adolescent spondylolisthesis?-a systematic review and meta-analysis","volume":"10","author":"Zhan X","year":"2021","unstructured":"Zhan X, Xi X, Li F,  Is reduction or arthrodesis in situ the optimal choice for adolescent spondylolisthesis?-a systematic review and meta-analysis. Ann Palliat Med. 2021;10(8):8523\u20138535."},{"key":"b9","series-title":"World Neurosurg","first-page":"512","article-title":"Reduction versus in situ fusion for adult high-grade spondylolisthesis: a systematic review and meta-analysis","volume":"138","author":"Lak AM","year":"2020","unstructured":"Lak AM, Abunimer AM, Devi S,  Reduction versus in situ fusion for adult high-grade spondylolisthesis: a systematic review and meta-analysis. 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Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36(3):1\u201348."},{"key":"b13","series-title":"BMJ","first-page":"l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne JAC","year":"2019","unstructured":"Sterne JAC, Savovi\u0107 J, Page MJ,  RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898."},{"key":"b14","series-title":"BMJ","first-page":"i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne JA","year":"2016","unstructured":"Sterne JA, Hern\u00e1n MA, Reeves BC,  ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. 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Reduction and transforaminal lumbar interbody fusion with posterior fixation versus transsacral cage fusion in situ with posterior fixation in the treatment of Grade 2 adult isthmic spondylolisthesis in the lumbosacral spine. J Neurosurg Spine. 2010;13(3):394\u2013400."},{"issue":"16","key":"b20","series-title":"Spine (Phila Pa 1976)","first-page":"1701","article-title":"Complications in the surgical treatment of pediatric high-grade, isthmic dysplastic spondylolisthesis. A comparison of three surgical approaches","volume":"24","author":"Molinari RW","year":"1999","unstructured":"Molinari RW, Bridwell KH, Lenke LG, Ungacta FF, Riew KD. Complications in the surgical treatment of pediatric high-grade, isthmic dysplastic spondylolisthesis. A comparison of three surgical approaches. 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Systematic review of observational studies reveals no association between low back pain and lumbar spondylolysis with or without isthmic spondylolisthesis. Eur Spine J. 2015;24(6):1289\u20131295."},{"issue":"1","key":"b23","series-title":"J Bone Joint Surg Am","first-page":"53","article-title":"Evidence-based surgical management of spondylolisthesis: reduction or arthrodesis in situ","volume":"96","author":"Longo UG","year":"2014","unstructured":"Longo UG, Loppini M, Romeo G, Maffulli N, Denaro V. Evidence-based surgical management of spondylolisthesis: reduction or arthrodesis in situ. J Bone Joint Surg Am. 2014;96(1):53\u201358."},{"issue":"3","key":"b24","series-title":"Eur Spine J","first-page":"606","article-title":"Is reduction better than arthrodesis in situ in surgical management of low-grade spondylolisthesis? 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Reduction and transforaminal lumbar interbody fusion with posterior fixation versus transsacral cage fusion in situ with posterior fixation in the treatment of Grade 2 adult isthmic spondylolisthesis in the lumbosacral spine. J Neurosurg Spine. 2010;13(3):394\u2013400."},{"issue":"16","key":"b20","series-title":"Spine (Phila Pa 1976)","first-page":"1701","article-title":"Complications in the surgical treatment of pediatric high-grade, isthmic dysplastic spondylolisthesis. A comparison of three surgical approaches","volume":"24","author":"Molinari RW","year":"1999","unstructured":"Molinari RW, Bridwell KH, Lenke LG, Ungacta FF, Riew KD. Complications in the surgical treatment of pediatric high-grade, isthmic dysplastic spondylolisthesis. A comparison of three surgical approaches. 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