Comparison of Decompression Alone Versus Decompression with Fusion for Stenotic Lumbar Spine: A Systematic Review and Meta-analysis

Abstract

The first line of treatment for lumbar spinal stenosis (with or without lumbar degenerative spondylolisthesis) involves conservative options such as anti-inflammatory drugs and analgesics. Approximately, 10%-15% of patients require surgery. Surgical treatment aims to decompress the spinal canal and dural sac from degenerative bony and ligamentous overgrowth. Different studies have given conflicting results. The aim of our study is to clear the confusion by comparing two surgical techniques. This meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A literature search was conducted of the Ovid Embase, Scopus, Pubmed, Ovid Medline, Google Scholar, and Cochrane library databases. A quality and risk of bias assessment was also done. The analysis was done using Revman software (The Nordic Cochrane Centre, The Cochrane Collaboration, 2014, Copenhagen, Denmark).A total of 76 studies were extracted from the literature search and 29 studies with relevant information were shortlisted. Nine studies were included in the meta-analysis after a quality assessment and eligibility. Fusion with decompression surgery was found to be a better technique when compared to decompression alone for spinal stenosis in terms of the Oswestry Disability index and the visual analog pain scale for back and leg pain. On the basis of the meta-analysis of the recent medical literature, the authors concluded that decompression with fusion is a 3.5-times better surgical technique than decompression alone for spinal stenosis.

Development of Endoscopic Spine Surgery for Healthy Life: To Provide Spine Care for Better, for Worse, for Richer, for Poorer, in Sickness and in Health

“…With a high prevalence of these conditions, such as spinal stenosis, spondylolisthesis, degenerative disc disease, and their associated spinal conditions, there is a demand for surgical techniques to provide effective decompression and fusion. 16 In headto-head comparisons with open and minimally invasive microscopic decompression and fusion, full endoscopic uniportal and endoscope-assisted biportal decompression and interbody fusion achieved equivalent patient-reported outcomes, with better facet preservation, shorter hospital stays, improved perioperative pain management, and a lower infection rate. [17][18][19] With the wide application of open and endoscopic spine decompression and fusion surgery in patients with degenerative spine disease, there has been a corresponding increase in patients who present with conditions requiring revision surgery.…”

Percutaneous Endoscopic Unilateral Laminotomy and Bilateral Decompression under 3D Real-Time Image-Guided Navigation for Spinal Stenosis in Degenerative Lumbar Kyphoscoliosis Patients: An Innovative Preliminary Study

“…However, decompression alone using endoscope for kyphoscoliosis patient is technically demanding and may result in unnecessary bone destruction leading to iatrogenic instability. [15,16] Considerable advances in 3D real-time image navigation have changed the nature of spine surgery. [17,18] With the assistance of 3D real-time image navigation, the depth and location of endoscope trocar, high speed burr and relevant anatomy could be instantly demonstrated on the monitor during the procedure.…”

Percutaneous Endoscopic Unilateral Laminotomy and Bilateral Decompression under 3D Real-Time Image-Guided Navigation for Spinal Stenosis in Degenerative Lumbar Kyphoscoliosis Patient: An Innovative Preliminary Study

“…However, decompression alone using endoscope for kyphoscoliosis patient is technically demanding and may result in unnecessary bone destruction leading to iatrogenic instability. [15,16] There have been studies discussing the limitation of uoroscopy-based spinal surgery. A number of studies reveal inaccuracies in pedicle screw placement under uoroscopy guidance especially when the anatomy is distorted and visual and tactile landmarks are not readily available to the spine surgeon.…”