The First Affiliated Hospital of Chongqing Medical University Dept. of Orthopaedics, Chongqing, China.
Department of Orthopaedics, Zaozhuang Hospital, Zaozhuang Mining Industry Group, Shandong Province, China.
Pain Physician. 2018 Jan;21(1):1-8.
Degenerative lumbar spinal stenosis (DLSS) is the main cause for chronic low back pain in the elderly. When refractory to conservative treatment, symptomatic patients commonly undergo surgery. However, whether or not fusion is a relatively better surgical option still remains unclear.
The purpose of the present study was to systematically review the clinical outcomes of spinal decompression with or without spinal fusion for DLSS.
A systematic review of the therapeutic effect for DLSS with or without fusion.
A literature search of 5 electronic databases was performed including PubMed, EMBASE, MEDLINE, Cochrane Library, and CENTRAL from inception to August 2016. Only randomized controlled trials (RCTs) assessing the comparison between decompression and fusion surgery for DLSS were included.
A total of 5 RCTs involving 438 patients met the inclusion criteria. Low-quality evidence of the meta-analysis was performed for the heterogeneity of the included studies. Pooled analysis showed no significant differences between decompression alone and fusion groups for the 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) were remarkably higher in the fusion group. Furthermore, there was no difference in the reoperation rate between these 2 groups at the latest follow-up (P = 0.49).
The methodological criteria and sample sizes were highly variable. The studies were heterogeneous.
The present meta-analysis is the first to compare the efficacy of decompression alone and spinal fusion for the treatment of DLSS, including 5 RCTs. Our results demonstrate that additional fusion surgery seems unlikely to result in better outcomes for patients with DLSS, but it may increase additional risks and costs. High-quality homogeneous research is required to provide further evidence about surgical procedures for patients with DLSS.
Decompression, fusion, lumbar spinal stenosis, meta-analysis.
退行性腰椎管狭窄症（DLSS）是老年人慢性下腰痛的主要原因。对于保守治疗无效的症状性患者，通常会进行手术。然而，融合是否是一种更好的手术选择尚不清楚。
本研究旨在系统评价减压术与减压融合术治疗 DLSS 的临床疗效。
对 DLSS 减压与融合治疗的疗效进行系统评价。
检索了 5 个电子数据库，包括 PubMed、EMBASE、MEDLINE、Cochrane Library 和 CENTRAL，检索时间截至 2016 年 8 月。仅纳入比较减压与融合手术治疗 DLSS 的随机对照试验（RCT）。
共纳入 5 项 RCT，包含 438 例患者。由于纳入研究的异质性，对其进行了低质量证据的 meta 分析。汇总分析显示，在基线时（P = 0.50）和 2 年随访时（P = 0.71），单纯减压组与融合组的 Oswestry 功能障碍指数（ODI）评分无显著差异，且两组的手术满意度也相似（P = 0.53）。然而，融合组的手术时间（P = 0.002）、出血量（P < 0.00001）和住院时间（P = 0.007）显著更长。此外，在末次随访时，两组的再手术率无差异（P = 0.49）。
研究方法学标准和样本量差异较大，研究存在异质性。
本 meta 分析首次比较了单纯减压与融合手术治疗 DLSS 的疗效，纳入了 5 项 RCT。我们的结果表明，对于 DLSS 患者，融合手术可能不会带来更好的结果，但会增加额外的风险和成本。需要高质量的同质研究为 DLSS 患者的手术提供进一步的证据。
减压；融合；腰椎管狭窄症；meta 分析。
