Decompression alone or decompression and fusion in degenerative lumbar spondylolisthesis

Wei, Fei-Long; Zhou, Cheng-Pei; Gao, Quan-You; Du, Ming-Rui; Gao, Haokao; Zhu, Ke; Li, Tian; Qian, Jixian; Yan, Xiaodong

doi:10.1016/j.eclinm.2022.101559

Cited by 23 publications

(19 citation statements)

References 53 publications

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“…We adhered to the Cochrane Handbook for Systematic Reviews of Interventions [ 12 ] and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines [ 13 , 14 ] to conduct this meta-analysis. The protocol was published in PROSPERO (CRD42020201167).…”

Section: Methodsmentioning

confidence: 99%

Efficacy and safety of pharmacologic therapies for prevention of osteoporotic vertebral fractures in postmenopausal women

Wei¹,

Gao²,

Zhu³

et al. 2023

Heliyon

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Section: Methodsmentioning

confidence: 99%

Efficacy and safety of pharmacologic therapies for prevention of osteoporotic vertebral fractures in postmenopausal women

Wei¹,

Gao²,

Zhu³

et al. 2023

Heliyon

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“…Data were analyzed using STATA 16.0 (Stata Corp, College Station, TX, USA). Data were pooled using a random-effects model ( 18 ). Dichotomous data were calculated as relative risks (RR) with 95% confidence intervals (CI).…”

Section: Methodsmentioning

confidence: 99%

Comparison of posterior decompression techniques and conventional laminectomy for lumbar spinal stenosis

et al. 2022

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ObjectivesTo compare the efficacy of posterior decompression techniques with conventional laminectomy for lumbar spinal stenosis.MethodsThe Embase, PubMed, and Cochrane Library databases were searched with no language limitations from inception to January 13, 2022. The main outcomes were functional disability, perceived recovery, leg and back pain, complications. A random effects model was used to pooled data. Risk ratio (RR), mean difference (MD) and 95% confidence interval (CI) were used to report results. The study protocol was published in PROSPERO (CRD42022302218).Results14 trials including 1,106 participants were included in the final analysis. Bilateral laminotomy was significantly more efficacious in improve functionality than laminectomy [MD: −2.94; (95% CI, −4.12 to −1.76)]. Low incidence of iatrogenic instability due to bilateral laminectomy compared with laminectomy [RR: 0.11; (95% CI, 0.02 to 0.59)]. In addition, between those who received bilateral laminotomy and those undergoing laminectomy, the result showed significant difference regarding recovery [RR: 1.31; (95% CI, 1.03 to 1.67)].ConclusionsThis study provides evidence that bilateral laminotomy has advantages in functional recovery, postoperative stability, and postoperative rehabilitation outcomes. Further research is needed to determine whether posterior techniques provide a safe and effective option for conventional laminectomy.

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“…Since then, another systematic review has been published. 14 However, most searched only for English-language studies, included studies with outdated and no longer used fusion techniques and inappropriately 15 combined the results of randomised controlled trials (RCTs) and pseudo-RCTs or observational studies in meta-analyses. None provided the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) assessment of certainty of evidence (COE).…”

Section: What This Study Addsmentioning

confidence: 99%

“…We found seven completed systematic reviews5–8 11–13 and four registered reviews (all completed and retrieved, see online supplemental appendix E). Since then, another systematic review has been published 14. However, most searched only for English-language studies, included studies with outdated and no longer used fusion techniques and inappropriately15 combined the results of randomised controlled trials (RCTs) and pseudo-RCTs or observational studies in meta-analyses.…”

Section: Introductionmentioning

confidence: 99%

Decompression alone versus decompression with instrumented fusion in the treatment of lumbar degenerative spondylolisthesis: a systematic review and meta-analysis of randomised trials

Kaiser

Kantorová

Langaufová

et al. 2023

J Neurol Neurosurg Psychiatry

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ObjectiveTo determine the efficacy of adding instrumented spinal fusion to decompression to treat degenerative spondylolisthesis (DS).DesignSystematic review with meta-analysis.Data sourcesMEDLINE, Embase, Emcare, Cochrane Library, CINAHL, Scopus, ProQuest Dissertations & Theses Global, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform from inception to May 2022.Eligibility criteria for study selectionRandomised controlled trials (RCTs) comparing decompression with instrumented fusion to decompression alone in patients with DS. Two reviewers independently screened the studies, assessed the risk of bias and extracted data. We provide the Grading of Recommendations, Assessment, Development and Evaluation assessment of the certainty of evidence (COE).ResultsWe identified 4514 records and included four trials with 523 participants. At a 2-year follow-up, adding fusion to decompression likely results in trivial difference in the Oswestry Disability Index (range 0–100, with higher values indicating greater impairment) with mean difference (MD) 0.86 (95% CI −4.53 to 6.26; moderate COE). Similar results were observed for back and leg pain measured on a scale of 0 to 100, with higher values indicating more severe pain. There was a slightly increased improvement in back pain (2-year follow-up) in the group without fusion shown by MD −5·92 points (95% CI −11.00 to −0.84; moderate COE). There was a trivial difference in leg pain between the groups, slightly favouring the one without fusion, with MD −1.25 points (95% CI −6.71 to 4.21; moderate COE). Our findings at 2-year follow-up suggest that omitting fusion may increase the reoperation rate slightly (OR 1.23; 0.70 to 2.17; low COE).ConclusionsEvidence suggests no benefits of adding instrumented fusion to decompression for treating DS. Isolated decompression seems sufficient for most patients. Further RCTs assessing spondylolisthesis stability are needed to determine which patients would benefit from fusion.PROSPERO registration numberCRD42022308267.

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Decompression alone or decompression and fusion in degenerative lumbar spondylolisthesis

Cited by 23 publications

References 53 publications

Efficacy and safety of pharmacologic therapies for prevention of osteoporotic vertebral fractures in postmenopausal women

Efficacy and safety of pharmacologic therapies for prevention of osteoporotic vertebral fractures in postmenopausal women

Comparison of posterior decompression techniques and conventional laminectomy for lumbar spinal stenosis

Decompression alone versus decompression with instrumented fusion in the treatment of lumbar degenerative spondylolisthesis: a systematic review and meta-analysis of randomised trials

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