Abdel-Fattah Abdel-Rahman, Bell Fraser, Boden Luke, Ferry Jamie, McCormick Conall, Ross Matthew, Cameron Isobel, Smith Toby, Baliga Santosh, Myint Phyo K
Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK; School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK.
School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK.
Surgeon. 2023 Feb;21(1):e23-e31. doi: 10.1016/j.surge.2022.02.008. Epub 2022 Mar 16.
The optimum surgical intervention for elderly patients with lumbar spinal stenosis (LSS) and low-grade degenerative-spondylolisthesis (LGDS) has been extensively debated. We conducted a systematic review and meta-analysis of randomised-controlled-trials (RCTs) comparing the effectiveness of decompression-alone against the gold-standard approach of decompression-with-fusion (D + F) in elderly patients with LSS and LGDS.
A systematic literature search was performed on published databases from inception to October-2021. English-language RCTs of elderly patients (mean age over-65) with LSS and LGDS, who had undergone DA or D + F were included. The quality and weight of evidence was assessed, and a meta-analysis performed.
Six RCTs (n = 531; mean age: 66.2 years; 57.8% female) were included. There was no difference in visual-analogue-scale (VAS) scores of back-pain (BP) or leg-pain (LP) at mean follow-up of 27.4 months between both DA and D + F groups (BP: mean-difference (MD)0.24, 95%CI: -0.38-0.85; LP MD:0.39, 95%CI: -0.34-1.11). No difference in disability, measured by Oswestry-Disability-Index scores, was found between both groups (MD:0.50, 95%CI: -3.31-4.31). However, patients in DA group had less hospital complications and fewer adverse events (total-surgical-complications OR:0.57, 95%CI: 0.36-0.90), despite a higher rate of worsening DS (OR:3.49, 95%CI: 1.05-11.65). No difference in BP or LP was found in subgroup-analysis of open-laminectomy compared to posterolateral-fusion (PLF) (BP: MD: -0.24, 95%CI: -1.80-1.32; LP MD:0.80, 95%CI: -0.95-2.55).
DA is not inferior to D + F in elderly patients with LSS and LGDS. DA carries a lower risk of hospital complications and fewer adverse events, however, surgeons should weigh these findings with the increased risk of DS progressing post-operatively.
老年腰椎管狭窄症（LSS）合并低度退变性椎体滑脱（LGDS）患者的最佳手术干预措施一直存在广泛争议。我们对随机对照试验（RCT）进行了系统评价和荟萃分析，比较单纯减压与减压融合（D + F）这一金标准方法对老年LSS和LGDS患者的有效性。
对从开始到2021年10月发表的数据库进行系统文献检索。纳入年龄在65岁以上、患有LSS和LGDS且接受过单纯减压（DA）或减压融合（D + F）的老年患者的英文RCT。评估证据的质量和权重，并进行荟萃分析。
纳入了6项RCT（n = 531；平均年龄：66.2岁；57.8%为女性）。在平均随访27.4个月时，DA组和D + F组之间的背痛（BP）或腿痛（LP）视觉模拟量表（VAS）评分无差异（BP：平均差（MD）0.24，95%置信区间：-0.38 - 0.85；LP MD：0.39，95%置信区间：-0.34 - 1.11）。两组之间在以Oswestry功能障碍指数评分衡量的功能障碍方面无差异（MD：0.50，95%置信区间：-3.31 - 4.31）。然而，DA组患者的医院并发症和不良事件较少（总手术并发症比值比：0.57，95%置信区间：0.36 - 0.90），尽管DS恶化率较高（比值比：3.49，95%置信区间：1.05 - 11.65）。与后外侧融合（PLF）相比，在开放椎板切除术的亚组分析中，BP或LP无差异（BP：MD：-0.24，95%置信区间：-1.80 - 1.32；LP MD：0.80，95%置信区间：-0.95 - 2.55）。
对于老年LSS和LGDS患者，DA并不劣于D + F。DA的医院并发症风险较低且不良事件较少，然而，外科医生应权衡这些结果与术后DS进展风险增加的情况。
