Huang Peng, Liu Zhenxiu, Liu Hong, Yu Yaqiong, Huang Liqun, Lu Min, Jin Xiaohong
Department of Pain, The First Affiliated Hospital of Soochow University, Suzhou, China.
Pain Pract. 2023 Apr;23(4):390-398. doi: 10.1111/papr.13193. Epub 2022 Dec 25.
Degenerative lumbar spinal stenosis (DLSS) is a complex clinical syndrome that leads to spinal compression. Decompression with fusion has been the most commonly used surgical procedure for treating DLSS symptoms for many years. However, the exact role of fusion and its effectiveness in DLSS therapy has recently been debated.
The main purpose of this study was to compare the efficacy and safety of decompression alone and decompression plus fusion in the treatment of DLSS with or without spondylolisthesis.
A systematic review and meta-analysis of the therapeutic effects of decompression for DLSS with or without the combination of fusion.
A literature search in five relevant databases, including Web of Science, PubMed, Embase, Medline, and Cochrane Library was performed from the inception of the database to March 2022. Only randomized controlled trials (RCTs) assessing the comparison between decompression and decompression plus fusion for DLSS were included.
A total of seven studies, 894 patients were analyzed in this meta-analysis. Among these, 443 patients were included in the decompression plus fusion group while 451 patients were included in the decompression alone group. Pooled analysis showed that the combination of decompression with fusion had no superior benefits to decompression alone in terms of Oswestry Disability Index (ODI) score in the first 2 years and long-term follow-up after surgery, also no significant difference in the improvement of back and leg pain was found between two groups. Adding fusion to decompression was associated with a longer operation time, higher complication rate, more blood loss, and extended hospital stay. Furthermore, there was no difference in reoperation rates and patients' satisfaction between the two groups at the last follow-up.
Decompression plus fusion may not be associated with a better clinical outcome in ODI scores and back or leg pain improvement but with a longer duration of operation time, extended hospital stay, and more blood loss.
退行性腰椎管狭窄症（DLSS）是一种导致脊髓受压的复杂临床综合征。多年来，减压融合术一直是治疗DLSS症状最常用的外科手术。然而，融合术的确切作用及其在DLSS治疗中的有效性最近受到了质疑。
本研究的主要目的是比较单纯减压与减压加融合术治疗伴或不伴椎体滑脱的DLSS的疗效和安全性。
对单纯减压或联合融合术治疗DLSS的疗效进行系统评价和荟萃分析。
从数据库建立至2022年3月，在五个相关数据库中进行文献检索，包括科学网、PubMed、Embase、Medline和Cochrane图书馆。仅纳入评估DLSS减压与减压加融合术比较的随机对照试验（RCT）。
本荟萃分析共纳入7项研究，894例患者。其中，减压加融合组纳入443例患者，单纯减压组纳入451例患者。汇总分析显示，减压融合术在术后前2年和长期随访的Oswestry功能障碍指数（ODI）评分方面，并不比单纯减压有更好的效果，两组在改善腰腿痛方面也无显著差异。减压加融合术与更长的手术时间、更高的并发症发生率、更多的失血量和更长的住院时间相关。此外，在末次随访时，两组的再次手术率和患者满意度无差异。
减压加融合术在ODI评分及改善腰腿痛方面可能不会带来更好的临床效果，反而会导致手术时间延长、住院时间延长和更多的失血量。
