Exercise versus surgical intervention for pain and disability in adults with lumbar spondylolisthesis

Hdl Handle:
http://hdl.handle.net/10149/621278
Title:
Exercise versus surgical intervention for pain and disability in adults with lumbar spondylolisthesis
Authors:
Dritsa, D.; Bettany-Saltikov, J. A. (Josette); Hanchard, N. C. A. (Nigel)
Affiliation:
Teesside University. Health and Social Care Institute
Journal:
Scoliosis and Spinal Disorders
Conference:
13th International Conference on Conservative Management of Spinal Deformities and First Joint Meeting of the International Research Society on Spinal Deformities and the Society on Scoliosis Orthopaedic and Rehabilitation Treatment – SOSORT-IRSSD 2016 meeting, Banff, Canada. 25-28 May 2016
Issue Date:
2017
URI:
http://hdl.handle.net/10149/621278
Abstract:
Spondylolisthesis (SPD) is a condition that directly affects the vertebra and is most commonly seen in the lumbar spine (Earl, 2002). It is a movement or translation of one vertebral body over the other. Slippage may be forward, backward, or sideways, but usually an anterolisthesis (forward movement) is implied by this term (Haun and Kettner, 2005). The most common types of SPD found in the adult population are isthmic and degenerative (Earl, 2002). Even though there are important differences in these two types of SPD, the treatment approach to this condition remains the same. The main management approaches for lumbar spondylolisthesis are conservative treatment, and surgery (Vibert et al., 2006). Both interventions have been proven to work independently but the question still remains as to which route is the most beneficial for a satisfactory clinical outcome both in the short and long-term. Objectives To determine whether exercise or surgery is more effective for the treatment of lumbar spondylolisthesis in adults. Methods A systematic search was conducted in MEDLINE, CINAHL, AMED, EMBASE, SPORTDISCUS, and EBMR for articles published through November 2015. PICO was used to design the selection criteria for relevant studies. Quality assessment was evaluated using the 'Physiotherapy Evidence Database' (PEDro). A narrative synthesis was conducted in order to analyse the relationships within and between the studies. Mean numerical values were presented as a mean difference (MD) and the findings were compared to determine potential heterogeneity of treatment effect. Results and discussion Three RCT's fulfilled all the inclusion criteria. Only one study showed substantially better results in pain and disability for surgery over exercise in the medium and long term (Moller and Hedlund, 2000). However, the evidence relating to efficacy is of low-moderate quality. Two studies reported that the benefits of surgery are likely to outweigh the possible harms (Moller and Hedlund, 2000; Weinstein et al., 2007). Sample size, differences in inclusion criteria, age groups, cultural backgrounds, types of exercise, surgery approaches, and outcome measures makes the effects of the studies included in this review difficult to assess for generalisability and applicability. Conclusion and significance Following a rigorous search strategy, 3 studies were identified and included in the final review. Internal and external validity was assessed and found to be low to moderate. The results found no significant differences between the two treatment strategies. Only Moller and Hedlund (2000) found posterolateral fusion to be more effective than exercise in the long term. Yet, methodological quality of this paper was low-moderate, thus the results should be used with caution. No clear conclusions were drawn for the best treatment strategy. Further research is very likely to influence the estimated effect of the studies.
Type:
Meetings and Proceedings
Language:
en

Full metadata record

DC FieldValue Language
dc.contributor.authorDritsa, D.en
dc.contributor.authorBettany-Saltikov, J. A. (Josette)en
dc.contributor.authorHanchard, N. C. A. (Nigel)en
dc.date.accessioned2017-07-11T14:16:09Z-
dc.date.available2017-07-11T14:16:09Z-
dc.date.issued2017-
dc.identifier.citationScoliosis and Spinal Disorders 2017, 12(Suppl 1):O64en
dc.identifier.urihttp://hdl.handle.net/10149/621278-
dc.description.abstractSpondylolisthesis (SPD) is a condition that directly affects the vertebra and is most commonly seen in the lumbar spine (Earl, 2002). It is a movement or translation of one vertebral body over the other. Slippage may be forward, backward, or sideways, but usually an anterolisthesis (forward movement) is implied by this term (Haun and Kettner, 2005). The most common types of SPD found in the adult population are isthmic and degenerative (Earl, 2002). Even though there are important differences in these two types of SPD, the treatment approach to this condition remains the same. The main management approaches for lumbar spondylolisthesis are conservative treatment, and surgery (Vibert et al., 2006). Both interventions have been proven to work independently but the question still remains as to which route is the most beneficial for a satisfactory clinical outcome both in the short and long-term. Objectives To determine whether exercise or surgery is more effective for the treatment of lumbar spondylolisthesis in adults. Methods A systematic search was conducted in MEDLINE, CINAHL, AMED, EMBASE, SPORTDISCUS, and EBMR for articles published through November 2015. PICO was used to design the selection criteria for relevant studies. Quality assessment was evaluated using the 'Physiotherapy Evidence Database' (PEDro). A narrative synthesis was conducted in order to analyse the relationships within and between the studies. Mean numerical values were presented as a mean difference (MD) and the findings were compared to determine potential heterogeneity of treatment effect. Results and discussion Three RCT's fulfilled all the inclusion criteria. Only one study showed substantially better results in pain and disability for surgery over exercise in the medium and long term (Moller and Hedlund, 2000). However, the evidence relating to efficacy is of low-moderate quality. Two studies reported that the benefits of surgery are likely to outweigh the possible harms (Moller and Hedlund, 2000; Weinstein et al., 2007). Sample size, differences in inclusion criteria, age groups, cultural backgrounds, types of exercise, surgery approaches, and outcome measures makes the effects of the studies included in this review difficult to assess for generalisability and applicability. Conclusion and significance Following a rigorous search strategy, 3 studies were identified and included in the final review. Internal and external validity was assessed and found to be low to moderate. The results found no significant differences between the two treatment strategies. Only Moller and Hedlund (2000) found posterolateral fusion to be more effective than exercise in the long term. Yet, methodological quality of this paper was low-moderate, thus the results should be used with caution. No clear conclusions were drawn for the best treatment strategy. Further research is very likely to influence the estimated effect of the studies.en
dc.language.isoenen
dc.titleExercise versus surgical intervention for pain and disability in adults with lumbar spondylolisthesisen
dc.typeMeetings and Proceedingsen
dc.contributor.departmentTeesside University. Health and Social Care Instituteen
dc.identifier.journalScoliosis and Spinal Disordersen
dc.identifier.conference13th International Conference on Conservative Management of Spinal Deformities and First Joint Meeting of the International Research Society on Spinal Deformities and the Society on Scoliosis Orthopaedic and Rehabilitation Treatment – SOSORT-IRSSD 2016 meeting, Banff, Canada. 25-28 May 2016en
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