Evaluation of the Therapeutic Effect of Decompression with or without Fusion on Lumbar Spinal Stenosis Caused by Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-Analysis

Abstract

Objective: As a common clinical disease, lumbar spinal stenosis (LSS) is currently the preferred surgical treatment, and there are various opinions. We conducted a study on whether fusion should be performed simultaneously with decompression for LSS caused by low-grade degenerative lumbar spondylolisthesis and compared the efficacy and safety of the 2 surgeries.

Methods: We conducted literature searches on Cochrane Library, Embase, PubMed, Scopus, and China National Knowledge Infrastructure databases to search for randomized controlled trials and observational studies that compared decompression alone and decompression plus fusion in the treatment of LSS with low-grade lumbar spondylolisthesis. We conducted a meta-analysis on surgical duration, hospital stay, incidence of complications, intraoperative blood loss, lower back and leg pain scores, and Oswestry Disability Index scores.

Results: We ultimately included 8 articles, including 2 randomized controlled trials and 6 observational studies. Additional fusion did not benefit patients in relieving lower back pain (P = 0.05) and leg pain (P = 0.12), and there was no significant difference in Oswestry Disability Index (P = 0.12) and perioperative complication rate (P = 0.10) between the 2. However, decompression alone was significantly better than the decompression plus fusion group in terms of surgical time (P = 0.0008), hospital stay (P < 0.0001), and intraoperative blood loss (P < 0.00001).

Conclusions: In this article, decompression alone has shorter surgical and hospitalization time and less intraoperative bleeding compared to decompression plus fusion. And there was no significant difference in pain score and disability index between the 2 surgeries during follow-up. Therefore, we can say that for patients with LSS caused by low-grade lumbar spondylolisthesis, decompression alone is not inferior to decompression plus fusion.

Keywords: Decompression; Degenerative lumbar spondylolisthesis; Fusion; Lumbar spinal stenosis; Meta-analysis.