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. 2022 Aug 23;7(1):42-51.
doi: 10.22603/ssrr.2022-0011. eCollection 2023 Jan 27.

Comparison between Decompression Alone and with Additional Fusion for Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-Analysis

Ida Bagus Gede Arimbawa  1 , Cokorda Gde Rama Adi Pranata  2 , Sonia Daniati  2 , Made Winatra Satya Putra  2 , Sherly Desnita Savio  2 , I Gusti Lanang Ngurah Agung Artha Wiguna  1 , Ketut Gede Mulyadi Ridia  1 , I Ketut Suyasa  1
Affiliations

Comparison between Decompression Alone and with Additional Fusion for Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-Analysis

Ida Bagus Gede Arimbawa et al. Spine Surg Relat Res. .

Abstract

Introduction: Degenerative lumbar spondylolisthesis affects approximately 10% of adults over 40. Although decompression has been the treatment of choice, some surgeons note possible instability development after decompression alone (D). Previous studies show that decompression with fusion (DF) has similar complication rates but is better at preventing slip progression and reducing pain. However, others stated the additional instrumentation does not result in superior functional outcomes and has higher costs and complication rates. This study aims to provide an objective, two-arm comparison of the two treatments using systematic review and meta-analysis.

Methods: The study design was a systematic review and meta-analysis of relevant randomized controlled trials and nonrandomized comparative studies. A systematic search was conducted from April 2021 to September 2021 to identify relevant studies using PubMed, Google Scholar, EMBASE, and Cochrane databases based on PRISMA guidelines.

Results: This systematic review included 8 studies (6,669 patients); 7 (6,569 patients) were included in the meta-analysis, with a follow-up period of up to 143 months. The most commonly affected level was L4-5, with females being more affected than males. Visual Analog Scale improvement on back pain was significantly better in DF group (Heterogeneity, I2=32%; WMD -0.72; 95% Confidence Interval (CI), -1.35 to -0.08; P=0.03), as well as postoperative back pain (I2=96%; WMD 0.87; 95% CI, 0.19 to 1.55; P=0.01). The leg pain, Oswestry Disability Index (ODI), satisfaction rate, complication rate, and revision rate were comparable between the two procedures.

Conclusions: Current systematic review and meta-analysis proved that DF is better than D in terms of back pain improvement, and the two procedures are comparable in terms of leg pain, ODI, satisfaction rate, complication rate, and revision rate.

Keywords: Decompression; Fusion; Lumbar Degenerative Spondylolisthesis.

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Conflict of interest statement

Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.

Figures

Figure 1.
Figure 1.
Flow Chart Showing Article Selection.
Figure 2.
Figure 2.
Forest Plot for VAS Improvement (Back).
Figure 3.
Figure 3.
Forest Plot for the Postoperative VAS (Leg).
Figure 4.
Figure 4.
Forest Plot for the Postoperative Oswestry Disability Index (ODI).
Figure 5.
Figure 5.
Forest Plot for the Complication Rate.
Figure 6.
Figure 6.
Forest Plot for the Revision Rate.
See this image and copyright information in PMC

References

    1. Yagi M, Fujita N, Okada E, et al. Comparisons of direct costs, outcomes, and cost-utility of decompression surgery with fusion versus decompression alone for degenerative lumbar spondylolisthesis. J Orthop Sci. 2018;23(4):653-7. doi:10.1016/j.jos.2018.04.001 - DOI - PubMed
    1. Inui T, Murakami M, Nagao N, et al. Lumbar degenerative spondylolisthesis: Changes in surgical indications and comparison of instrumented fusion with two surgical decompression procedures. Spine (Phila Pa 1976). 2017;42(1):E15-E24. doi:10.1097/BRS.0000000000001688 - DOI - PubMed
    1. Försth P, Michaëlsson K, Sandén B. Does fusion improve the outcome after decompressive surgery for lumbar spinal stenosis? A two-year follow-up study involving 5390 patients. Bone Jt J. 2013;95 B(7):960-5. doi:10.1302/0301-620X.95B7.30776 - DOI - PubMed
    1. Austevoll IM, Gjestad R, Brox JI, et al. The effectiveness of decompression alone compared with additional fusion for lumbar spinal stenosis with degenerative spondylolisthesis: a pragmatic comparative non-inferiority observational study from the Norwegian Registry for Spine Surgery. Eur Spine J. 2017;26(2):404-13. doi:10.1007/s00586-016-4683-1 - DOI - PubMed
    1. Kimura R, Yoshimoto M, Miyakoshi N, et al. Comparison of Posterior Lumbar Interbody Fusion and Microendoscopic Muscle-preserving Interlaminar Decompression for Degenerative Lumbar Spondylolisthesis With >5-Year Follow-up. Clin Spine Surg. 2019;32(8):E380-E385. doi:10.1097/BSD.0000000000000883 - DOI - PubMed

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