Manipulation for degenerative lumbar spondylolisthesis:A systematic review of randomized controlled trials

Objective: To assess the effectiveness and safety of manipulation intervention for degenerative lumbar spondylolisthesis(DLS).Methods: This is a systematic review and meta-analysis. A full-scale retrieval method was performed until February 1, 2021, including nine databases. The homogeneity of different studies was summarized using the Review Manager. The quality of studies was determined with the Cochrane risk-of-bias tool.The evidence quality was graded with the Grading of Recommendations, Assessment, Development, and Evaluations approach.Results: A total of 6 studies involving 524 participants were included. The review demonstrated that manipulation has statistically significant improvements for treating DLS according to Japanese Orthopedic Association scores(mean difference, 3.76;95% confidence interval, 2.63 to 4.90;P <.001) and visual analog scale scores(mean difference,-1.50;95% confidence interval,-1.66 to-1.33;P <.001)compared to the control group. One study reported that the difference in the Oswestry Disability Index between the traction group and the combination of manipulation and traction group was statistically significant(P <.05), while another reported that manipulation treatment can significantly improve the lumbar spine rotation angle on X-ray images compared with the baseline data(P <.05). Moreover, the manipulation group(experimental group) had fewer adverse events than the lumbar traction group(control group).Conclusion: Manipulation intervention is more effective and safer for DLS. Nevertheless, large-scale randomized controlled trials are required to confirm the current conclusions.

Hot Spots and Frontiers of Research on Degenerative Lumbar Spondylolisthesis in China-Visualization Analysis Based on Citespace

Objective:Through the presentation and visual analysis of the Citespace knowledge map,the future research hotspots and trends of domestic research on degenerative lumbar spondylolisthesis are predicted.Methods:By searching the relevant literature on"degenerative lumbar spondylolisthesis"included in the CNKI database from the establishment of the database to January 1,2021,the annual publication volume,fund projects,research authors,research institutions,and research of the included literature For hotspots and other aspects,visual analysis was carried out with the help of Citespace software.Results:(1)A total of 266 related documents were included,of which 27 were published at the end of 2020;(2)The most funded projects are the National Natural Science Foundation of China(9 projects)and the National Science and Technology Support Program(5 projects);(3)In terms of author analysis,Zhu Liguo(16 articles),Yu Jie(13 articles),and Gao Chunyu(8 articles)rank the top three in terms of author analysis;(4)In terms of research institutions,Wangjing Hospital of China Academy of Chinese Medical Sciences(17 articles),Henan University of Chinese Medicine(4 articles),and Nanjing University of Chinese Medicine(4 articles)were the top 3 research institutions in terms of publication volume;(5)The keyword clustering label was"degenerative lumbar spondylolisthesis","lumbar spine","lumbar spondylolisthesis","degenerative lumbar spondylolisthesis","clinical observation"and"tuina".Conclusion:Research on"degenerative lumbar spondylolisthesis"has gradually received widespread attention,but the amount of publications is still relatively small;relevant domestic researchers and research institutions have formed a certain degree of influence across the country,but large-scale national cooperation research is still scarce,and strengthening academic exchanges and cooperation is still an important direction for researchers and research institutions in this field in the future.The research direction of lumbar spinal stenosis caused by degenerative lumbar spondylolisthesis will be a new direction and entry point for the study of degenerative lumbar spondylolisthesis in recent years.

Adjacent segment disease following Dynesys stabilization for lumbar disorders:A case series of mid-and long-term follow-ups

BACKGROUND Radiologic adjacent segment degeneration(ASDeg)can occur after spinal surgery.Adjacent segment disease(ASDis)is defined as the development of new clinical symptoms corresponding to radiographic changes adjacent to the level of previous spinal surgery.Greater pre-existing ASDeg is generally considered to result in more severe ASDis;nonetheless,whether the ASDeg status before index surgery influences the postoperative risk of revision surgery due to ASDis warrants investigation.AIM To identify possible risk factors for ASDis and verify the concept that greater preexisting ASDeg leads to more severe ASDis.METHODS Data from 212 patients who underwent posterior decompression with Dynesys stabilization from January 2006 to June 2016 were retrospectively analyzed.Patients who underwent surgery for ASDis were categorized as group A(n=13),whereas those who did not were classified as group B(n=199).Survival analysis and Cox proportional hazards models were used to compare the modified Pfirrmann grade,University of California-Los Angeles grade,body mass index,number of Dynesys-instrumented levels,and age.RESULTS The mean time of reoperation was 7.22(1.65–11.84)years in group A,and the mean follow-up period was 6.09(0.10–12.76)years in group B.No significant difference in reoperation risk was observed:Modified Pfirrmann grade 3 vs 4(P=0.53)or 4 vs 5(P=0.46)for the upper adjacent disc,University of California-Los Angeles grade 2 vs 3 for the upper adjacent segment(P=0.66),age of<60 vs>60 years(P=0.9),body mass index<25 vs>25 kg/m2(P=0.3),and sex(P=0.8).CONCLUSION Greater preexisting upper ASDeg was not associated with a higher rate of reoperation for ASDis after Dynesys surgery.Being overweight tended to increase reoperation risk after Dynesys surgery for ASDis.