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.