Decompression with fusion in the treatment of lumbar spinal stenosis: a meta-analysis

The present study investigated whether spinal fusion with decompression has a better effect than decompression alone in the treatment of patients with lumbar spinal stenosis (LSS). The surgical methods of degenerative LSS include spinal decompression with or without spinal fusion. The treatment of spinal stenosis by surgery has increased rapidly in the past two decades; however, its efficacy is yet controversial. PubMed, Embase, and Cochrane library databases were searched for randomized controlled trials and cohort studies published up to October 31, 2016. The meta-analysis was performed using random or fixed effects model. A total of 29 studies were identified with data assimilated from 27380 patients. The pooled results showed that decompression plus fusion was similar to the decompression on dural tear rate [risk ratios (RR) = 1.05, 95% confidence interval (CI): 0.70-1.55], clinical outcome (RR = 0.93, 95% CI: 0.85-1.01), reoperation rate (RR = 0.94, 95% CI: 0.87-1.02), wound infection rate (RR = 0.56, 95% CI: 0.29-1.07), Oswestry disability index [weighted mean differences (WMD) = -2.22, 95% CI: -2.84-1.59], and European quality of life-5 dimensions score (WMD = -0.00, 95% CI: -0.02-0.02); the former was inferior to the latter in terms of surgery duration (WMD = -95.63, 95% CI: -128.75-62.51), blood loss (WMD = -413.02, 95% CI: -562.80-263.23), and hospital stay (WMD = -2.22, 95% CI: -2.84-1.59). Thus, decompression with fusion was found to have fewer benefits than decompression alone for the treatment of LSS.