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
A Letter to the Editor Regarding “Fusion or Not
for Degenerative Lumbar Spinal Stenosis:
A Meta-Analysis and Systematic Review”
