Effectiveness and safety of decompression alone versus decompression plus fusion for lumbar spinal stenosis with degenerative spondylolisthesis: a systematic review and meta-analysis

Zhubin Shen; Xiaojing Guan; Rui Wang; Qian Xue; Ding Zhang; Yuan Zong; Wenxuan Ma; Ruijian Zhuge; Zhiming Liu; Changhao He; Li Guo; Fei Yin

doi:10.21037/atm-22-2208

Effectiveness and safety of decompression alone versus decompression plus fusion for lumbar spinal stenosis with degenerative spondylolisthesis: a systematic review and meta-analysis

Ann Transl Med. 2022 Jun;10(12):664. doi: 10.21037/atm-22-2208.

Authors

Zhubin Shen¹, Xiaojing Guan¹, Rui Wang², Qian Xue², Ding Zhang¹, Yuan Zong¹, Wenxuan Ma², Ruijian Zhuge², Zhiming Liu¹, Changhao He², Li Guo², Fei Yin¹

Affiliations

¹ Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun, China.
² Department of Toxicology, School of Public Health of Jilin University, Changchun, China.

Abstract

Background: There have been lingering controversies reported decompression and plus fusion. And the relative safety of fusion in addition to standard decompression remains unclear. This study aimed to assess the effectiveness and safety of decompression alone or combined with fusion in lumbar spinal stenosis (LSS) with degenerative spondylolisthesis (DS).

Methods: In this systematic review and meta-analysis, we searched the databases of PubMed, Embase, Cochrane Library, and Web of Science for relevant literature from their inception to 28th December 2021. We identified the eligible studies based on the PICOS principles, populations (LSS with DS), interventions (decompression alone), controls (decompression combined with fusion), outcomes [overall reoperation rate, complications, Oswestry Disability Index (ODI), operative time, the amount of blood lost, length of stay (LOS), and visual analog scales (VAS)], study design (cohort studies). Quality assessment for individual study was performed with the Newcastle-Ottawa Scale (NOS).

Results: In all, 12 articles involving a total of 14,693 patients were finally included in the study, the majority of patients underwent decompression alone (DA group: n=11,598) and the rest underwent decompression associated with fusion (FU group: n=3,095). The quality of most of the included studies was regarded as high quality. The results indicated that the FU group had a higher rate of complication [relative risk (RR): 1.770, 95% confidence interval (CI): 1.485 to 2.110], longer operative time [weighted mean difference (WMD): 51.037, 95% CI: 13.743 to 88.330], and increased blood loss (WMD: 258.354, 95% CI: 150.468 to 366.239) than the DA group (all P<0.05), with no significant differences for overall reoperation rate (RR: 0.879, 95% CI: 0.432 to 1.786), ODI (WMD: -2.569, 95% CI: -6.548 to 1.409), LOS (WMD: 3.838, 95% CI: -2.172 to 9.848), and VAS found between the two groups (P>0.05).

Conclusions: In patients with LSS + DS, the effectiveness and safety of decompression alone may be superior to decompression plus fusion in terms of complication rate, operative time, and the amount of bleeding. However, more high-quality literature is needed in the future to confirm the best treatment choice for patients with LSS + DS.

Keywords: Lumbar spinal stenosis (LSS); decompression; degenerative spondylolisthesis (DS); fusion; meta-analysis.