Arimbawa Ida Bagus Gede, Pranata Cokorda Gde Rama Adi, Daniati Sonia, Putra Made Winatra Satya, Savio Sherly Desnita, Wiguna I Gusti Lanang Ngurah Agung Artha, Ridia Ketut Gede Mulyadi, Suyasa I Ketut
Consultant of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia.
Resident of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia.
Spine Surg Relat Res. 2022 Aug 23;7(1):42-51. doi: 10.22603/ssrr.2022-0011. eCollection 2023 Jan 27.
Degenerative lumbar spondylolisthesis affects approximately 10% of adults over 40. Although decompression has been the treatment of choice, some surgeons note possible instability development after decompression alone (D). Previous studies show that decompression with fusion (DF) has similar complication rates but is better at preventing slip progression and reducing pain. However, others stated the additional instrumentation does not result in superior functional outcomes and has higher costs and complication rates. This study aims to provide an objective, two-arm comparison of the two treatments using systematic review and meta-analysis.
The study design was a systematic review and meta-analysis of relevant randomized controlled trials and nonrandomized comparative studies. A systematic search was conducted from April 2021 to September 2021 to identify relevant studies using PubMed, Google Scholar, EMBASE, and Cochrane databases based on PRISMA guidelines.
This systematic review included 8 studies (6,669 patients); 7 (6,569 patients) were included in the meta-analysis, with a follow-up period of up to 143 months. The most commonly affected level was L4-5, with females being more affected than males. Visual Analog Scale improvement on back pain was significantly better in DF group (Heterogeneity, I=32%; WMD -0.72; 95% Confidence Interval (CI), -1.35 to -0.08; P=0.03), as well as postoperative back pain (I=96%; WMD 0.87; 95% CI, 0.19 to 1.55; P=0.01). The leg pain, Oswestry Disability Index (ODI), satisfaction rate, complication rate, and revision rate were comparable between the two procedures.
Current systematic review and meta-analysis proved that DF is better than D in terms of back pain improvement, and the two procedures are comparable in terms of leg pain, ODI, satisfaction rate, complication rate, and revision rate.
退行性腰椎滑脱影响约10%的40岁以上成年人。尽管减压一直是首选治疗方法，但一些外科医生指出，单纯减压（D）后可能会出现不稳定。先前的研究表明，减压融合术（DF）的并发症发生率相似，但在预防滑脱进展和减轻疼痛方面效果更好。然而，其他人指出，额外的内固定并不会带来更好的功能结果，且成本更高、并发症发生率更高。本研究旨在通过系统评价和荟萃分析对这两种治疗方法进行客观的双臂比较。
研究设计为对相关随机对照试验和非随机对照研究进行系统评价和荟萃分析。根据PRISMA指南，于2021年4月至2021年9月进行系统检索，以使用PubMed、谷歌学术、EMBASE和Cochrane数据库识别相关研究。
本系统评价纳入8项研究（6669例患者）；7项研究（6569例患者）纳入荟萃分析，随访期长达143个月。最常受累节段为L4-5，女性比男性受累更严重。DF组背痛的视觉模拟量表改善情况显著更好（异质性，I=32%；加权均数差-0.72；95%置信区间（CI），-1.35至-0.08；P=0.03），术后背痛也是如此（I=96%；加权均数差0.87；95%CI，0.19至1.55；P=0.01）。两种手术在腿痛、Oswestry功能障碍指数（ODI）、满意率、并发症发生率和翻修率方面相当。
当前的系统评价和荟萃分析证明，在改善背痛方面，DF优于D，两种手术在腿痛、ODI、满意率、并发症发生率和翻修率方面相当。
