Interspinous process devices(IPD) alone versus decompression surgery for lumbar spinal stenosis(LSS): A systematic review and meta-analysis of randomized controlled trials

Abstract

Background: and purpose: Interspinous process devices (IPD) were widely used for the treatment of lumbar spinal stenosis (LSS). However, whether IPD was superior to bony decompression was still debated. We aimed to compare the clinical outcomes of IPD to bony decompression for LSS.

Methods: PubMed, Cochrane library, Cochrane Central Register of Controlled Trials (CCTR), Ovid Medline, China national knowledge internet database, Wan Fang database were searched in August.8th.2016. Studies were identified using selection criteria and analysed was performed with Review Manager Version 5.3.

Results: Four RCTs (seven articles) were included, with 200 patients in the interspinous process devices (IPD) group and 200 patients in bony decompression (DP) group. There was no significant difference in hospital stay time (P = 0.36), VAS leg pain scores (P = 0.83), and complication rates (P = 0.20) for IPD alone versus bony decompression. However, IPD alone showed higher VAS low back pain scores (P = 0.03) and reoperation rates (P < 0.0001) between the two therapy groups. Two studies' results showed the IPD group had lower cost-effectiveness.

Conclusions: Although patients who received IPD may obtain several benefits in the short term, it was associated with higher costs, reoperation rates. Both IPD and bony decompression were acceptable strategies for LSS, but the risks, indications, and costs of IPD should be carefully taken into account before surgery.

Keywords: Bony decompression (DP); Interspinous process devices (IPD); Laminectomy; Lumbar spinal stenosis(LSS); Randomized controlled trials (RCTs); Systematic review and meta-analysis.