Wei Fei-Long, Zhou Cheng-Pei, Gao Quan-You, Du Ming-Rui, Gao Hao-Ran, Zhu Kai-Long, Li Tian, Qian Ji-Xian, Yan Xiao-Dong
Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China.
School of Basic Medicine, Fourth Military Medical University, 710032, Xi'an, China.
EClinicalMedicine. 2022 Jul 16;51:101559. doi: 10.1016/j.eclinm.2022.101559. eCollection 2022 Sep.
Clinically, there are substantive practice variations in surgical management of degenerative lumbar spondylolisthesis. We aimed at evaluating whether decompression alone outcomes for patients with degenerative lumbar spondylolisthesis are comparable to those of decompression with fusion.
In this meta-analysis, the Embase, PubMed, and Cochrane Library databases were searched from inception to February 16th, 2022. Randomised controlled trials (RCTs) and cohort studies comparing decompression alone with decompression and fusion for patients with degenerative lumbar spondylolisthesis were included in this study. There were no language limitations. Odds ratio (OR), mean difference (MD) and 95% confidence interval (CI) were used to report results in the random-effects model. Main outcomes included Oswestry disability index (ODI), pain, clinical satisfaction, complication and reoperation rates. The study protocol was published in PROSPERO (CRD42022310645).
Thirty-three studies (6 RCTs and 27 cohort studies) involving 94 953 participants were included. Differences in post-operative ODI between decompression alone and decompression with fusion were not significant. A small difference for back (MD, 0.13; [95% CI, 0.08 to 0.18]; :0.00%) and leg pain (MD, 0.30; [95% CI, 0.09 to 0.51]; :48.35%) was observed on the 3rd post-operative month. The results did not reveal significant differences in leg pain and back pain between decompression alone and fusion groups on the 6th, 12th, and 24th post-operative months. Difference in clinical satisfaction between decompression alone and decompression with fusion were not significant from RCTs (OR, 0.26; [95% CI, 0.03 to 1.92]; :83.27%). Complications (OR, 1.54; [95% CI, 1.16 to 2.05]; :48.88%), operation time (MD, 83.39; [95% CI, 55.93 to 110.85]; :98.75%), intra-operative blood loss (MD, 264.58; [95% CI, 174.99 to 354.16]; :95.61%) and length of hospital stay (MD, 2.85; [95% CI, 1.60 to 4.10]; :99.49%) were higher with fusion.
Clinical effectiveness of decompression alone was comparable to that of decompression with fusion for degenerative lumbar spondylolisthesis. Decompression alone is recommended for patients with degenerative lumbar spondylolisthesis.
This work was supported by grants from the National Natural Science Foundation of China (No. 81871818), Tangdu Hospital Seed Talent Program (Fei-Long Wei), Natural Science Basic Research Plan in Shaanxi Province of China (No.2019JM-265) and Social Talent Fund of Tangdu Hospital (No.2021SHRC034).
临床上，退行性腰椎滑脱的手术治疗存在实质性的实践差异。我们旨在评估单纯减压治疗退行性腰椎滑脱患者的疗效是否与减压融合术相当。
在这项荟萃分析中，检索了Embase、PubMed和Cochrane图书馆数据库，检索时间从建库至2022年2月16日。纳入比较单纯减压与减压融合术治疗退行性腰椎滑脱患者的随机对照试验（RCT）和队列研究。无语言限制。采用比值比（OR）、平均差（MD）和95%置信区间（CI）在随机效应模型中报告结果。主要结局包括Oswestry功能障碍指数（ODI）、疼痛、临床满意度、并发症和再手术率。该研究方案已发表在PROSPERO（CRD42022310645）上。
纳入33项研究（6项RCT和27项队列研究），共94953名参与者。单纯减压与减压融合术后ODI的差异无统计学意义。术后第3个月，背部疼痛（MD，0.13；[95%CI，0.08至0.18]；P=0.00%）和腿部疼痛（MD，0.30；[95%CI，0.09至0.51]；P=48.35%）有微小差异。术后第6、12和24个月，单纯减压组与融合组在腿部疼痛和背部疼痛方面的结果未显示出显著差异。RCT显示单纯减压与减压融合术在临床满意度上的差异无统计学意义（OR，0.26；[95%CI，0.03至1.92]；P=83.27%）。融合术的并发症（OR，1.54；[95%CI，1.16至2.05]；P=48.88%）、手术时间（MD，83.39；[95%CI，55.93至110.85]；P=98.75%）、术中失血量（MD，264.58；[95%CI，174.99至354.16]；P=95.61%）和住院时间（MD，2.85；[95%CI，1.60至4.10]；P=99.49%）更高。
单纯减压治疗退行性腰椎滑脱的临床疗效与减压融合术相当。对于退行性腰椎滑脱患者，建议采用单纯减压治疗。
本研究得到中国国家自然科学基金（编号81871818）、唐都医院种子人才计划（魏飞龙）、中国陕西省自然科学基础研究计划（编号2019JM-265）和唐都医院社会人才基金（编号2021SHRC034）的资助。
