Fusion or Not for Degenerative Lumbar Spinal Stenosis: A Meta-Analysis and Systematic Review

摘要

Background: Degenerative lumbar spinal stenosis (DLSS) is the main cause for chronic low backpain in the elderly. When refractory to conservative treatment, symptomatic patients commonlyundergo surgery. However, whether or not fusion is a relatively better surgical option still remainsunclear.Objective: The purpose of the present study was to systematically review the clinical outcomesof spinal decompression with or without spinal fusion for DLSS.Study Design: A systematic review of the therapeutic effect for DLSS with or without fusion.Methods: A literature search of 5 electronic databases was performed including PubMed,EMBASE, MEDLINE, Cochrane Library, and CENTRAL from inception to August 2016. Onlyrandomized controlled trials (RCTs) assessing the comparison between decompression and fusionsurgery for DLSS were included.Results: A total of 5 RCTs involving 438 patients met the inclusion criteria. Low-quality evidenceof the meta-analysis was performed for the heterogeneity of the included studies. Pooledanalysis showed no significant differences between decompression alone and fusion groups forthe Oswestry Disability Index (ODI) scores at the baseline (P = 0.50) and 2 years follow-up (P =0.71), and the satisfaction rate of operations was also similar for the groups (P = 0.53). However,operation time (P = 0.002), blood loss (P < 0.00001), and length of hospital stay (P = 0.007) wereremarkably higher in the fusion group. Furthermore, there was no difference in the reoperationrate between these 2 groups at the latest follow-up (P = 0.49).Limitation: The methodological criteria and sample sizes were highly variable. The studies wereheterogeneous.Conclusion: The present meta-analysis is the first to compare the efficacy of decompressionalone and spinal fusion for the treatment of DLSS, including 5 RCTs. Our results demonstrate thatadditional fusion surgery seems unlikely to result in better outcomes for patients with DLSS, but itmay increase additional risks and costs. High-quality homogeneous research is required to providefurther evidence about surgical procedures for patients with DLSS.