1. 2018;21;1-8Fusion or Not for Degenerative Lumbar Spinal Stenosis: A Meta-Analysis and Systematic Review
   Systematic Review
   Jieliang Shen, PhD, Shen Xu, MD, Shenxi Xu, MD, Sen Ye, MD, and Jie Hao, PhD.

BACKGROUND: Degenerative lumbar spinal stenosis (DLSS) is the main cause for chronic low back pain in the elderly. When refractory to conservative treatment, symptomatic patients commonly undergo surgery. However, whether or not fusion is a relatively better surgical option still remains unclear.

OBJECTIVE: The purpose of the present study was to systematically review the clinical outcomes of spinal decompression with or without spinal fusion for DLSS.

STUDY DESIGN: A systematic review of the therapeutic effect for DLSS with or without fusion.

METHODS: A literature search of 5 electronic databases was performed including PubMed, EMBASE, MEDLINE, Cochrane Library, and CENTRAL from inception to August 2016. Only randomized controlled trials (RCTs) assessing the comparison between decompression and fusion surgery for DLSS were included.

RESULTS: A total of 5 RCTs involving 438 patients met the inclusion criteria. Low-quality evidence of the meta-analysis was performed for the heterogeneity of the included studies. Pooled analysis showed no significant differences between decompression alone and fusion groups for the Oswestry Disability Index (ODI) scores at the baseline (P = 0.50) and 2 years follow-up (P = 0.71), and the satisfaction rate of operations was also similar for the groups (P = 0.53). However, operation time (P = 0.002), blood loss (P < 0.00001), and length of hospital stay (P = 0.007) were remarkably higher in the fusion group. Furthermore, there was no difference in the reoperation rate between these 2 groups at the latest follow-up (P = 0.49).

LIMITATION: The methodological criteria and sample sizes were highly variable. The studies were heterogeneous.

CONCLUSION: The present meta-analysis is the first to compare the efficacy of decompression alone and spinal fusion for the treatment of DLSS, including 5 RCTs. Our results demonstrate that additional fusion surgery seems unlikely to result in better outcomes for patients with DLSS, but it may increase additional risks and costs. High-quality homogeneous research is required to provide further evidence about surgical procedures for patients with DLSS.

KEY WORDS: Decompression, fusion, lumbar spinal stenosis, meta-analysis