Guo Jie, Fan Yonggang, Diao Han, Fan Jigeng, Zhang Jiawei, Li Jianwei, Xiao Donglun, Su Runbang, Zhang Ying, Sun Tianwei
Graduate School of Tianjin Medical University, Tianjin, China; Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin, China.
School of Medicine, Nankai University, Tianjin, China; Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin, China.
World Neurosurg. 2025 Feb;194:123512. doi: 10.1016/j.wneu.2024.11.095. Epub 2024 Dec 12.
As a common clinical disease, lumbar spinal stenosis (LSS) is currently the preferred surgical treatment, and there are various opinions. We conducted a study on whether fusion should be performed simultaneously with decompression for LSS caused by low-grade degenerative lumbar spondylolisthesis and compared the efficacy and safety of the 2 surgeries.
We conducted literature searches on Cochrane Library, Embase, PubMed, Scopus, and China National Knowledge Infrastructure databases to search for randomized controlled trials and observational studies that compared decompression alone and decompression plus fusion in the treatment of LSS with low-grade lumbar spondylolisthesis. We conducted a meta-analysis on surgical duration, hospital stay, incidence of complications, intraoperative blood loss, lower back and leg pain scores, and Oswestry Disability Index scores.
We ultimately included 8 articles, including 2 randomized controlled trials and 6 observational studies. Additional fusion did not benefit patients in relieving lower back pain (P = 0.05) and leg pain (P = 0.12), and there was no significant difference in Oswestry Disability Index (P = 0.12) and perioperative complication rate (P = 0.10) between the 2. However, decompression alone was significantly better than the decompression plus fusion group in terms of surgical time (P = 0.0008), hospital stay (P < 0.0001), and intraoperative blood loss (P < 0.00001).
In this article, decompression alone has shorter surgical and hospitalization time and less intraoperative bleeding compared to decompression plus fusion. And there was no significant difference in pain score and disability index between the 2 surgeries during follow-up. Therefore, we can say that for patients with LSS caused by low-grade lumbar spondylolisthesis, decompression alone is not inferior to decompression plus fusion.
腰椎管狭窄症（LSS）作为一种常见的临床疾病，目前首选手术治疗，且存在多种观点。我们针对低度退变性腰椎滑脱所致LSS减压时是否应同时行融合术展开研究，并比较了这两种手术的疗效和安全性。
我们在Cochrane图书馆、Embase、PubMed、Scopus和中国知网数据库中进行文献检索，以查找比较单纯减压与减压加融合治疗低度腰椎滑脱所致LSS的随机对照试验和观察性研究。我们对手术时长、住院时间、并发症发生率、术中失血量、腰腿痛评分及Oswestry功能障碍指数评分进行了荟萃分析。
我们最终纳入8篇文章，其中包括2篇随机对照试验和6篇观察性研究。额外的融合术在缓解腰痛（P = 0.05）和腿痛（P = 0.12）方面对患者并无益处，且二者在Oswestry功能障碍指数（P = 0.12）和围手术期并发症发生率（P = 0.10）上无显著差异。然而，单纯减压在手术时间（P = 0.0008）、住院时间（P < 0.0001）和术中失血量（P < 0.00001）方面显著优于减压加融合组。
在本文中，与减压加融合相比，单纯减压的手术和住院时间更短，术中出血更少。且在随访期间，两种手术的疼痛评分和功能障碍指数无显著差异。因此，可以说对于低度腰椎滑脱所致LSS患者，单纯减压并不逊色于减压加融合。
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