Top

European Spine Journal

Published in:

01-12-2017 | Review

Decompression plus fusion versus decompression alone for degenerative lumbar spondylolisthesis: a systematic review and meta-analysis

Authors: Hai-Feng Liang, Shu-Hao Liu, Zi-Xian Chen, Qin-Ming Fei

Published in: European Spine Journal | Issue 12/2017

Abstract

Purpose

To compare the clinical effectiveness of decompression plus fusion and decompression alone for patients with degenerative lumbar spondylolisthesis, a systematic review and meta-analysis of all available evidence was performed.

Methods

A search of the literature was conducted on PubMed/MEDLINE, EMBASE, and the Cochrane Collaboration Library. Relevant studies comparing decompression plus fusion and decompression alone were selected according to eligibility criteria. Predefined endpoints were extracted and meta-analyzed from the identified studies.

Results

Four randomized controlled trials and 13 observational studies were eligible. The pooled data revealed that fusion was associated with significantly higher rates of satisfaction and lower leg pain scores when compared with decompression alone. However, fusion significantly increased the intraoperative blood loss, operative time and hospital stay. Both techniques had similar ODI, back pain scores, complication rate, and reoperation rate.

Conclusions

Based on the available evidence, decompression plus fusion maybe be better than decompression alone in the treatment of degenerative spondylolisthesis. Fusion had advantages of improvement of clinical satisfaction, as well as reduction of postoperative leg pain, with similar complication rate to decompression alone.

Weinstein JN, Lurie JD, Tosteson TD, Zhao W, Blood EA, Tosteson AN, Birkmeyer N, Herkowitz H, Longley M, Lenke L, Emery S, Hu SS (2009) Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. Four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Jt Surg Am 91(6):1295–1304. doi:10.2106/jbjs.h.00913 CrossRef

Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, Birkmeyer NJ, Hilibrand AS, Herkowitz H, Cammisa FP, Albert TJ, Emery SE, Lenke LG, Abdu WA, Longley M, Errico TJ, Hu SS (2007) Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 356(22):2257–2270. doi:10.1056/NEJMoa070302 CrossRefPubMedPubMedCentral

Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT (1997) 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine (Phila Pa 1976) 22(24):2807–2812CrossRef

Ghogawala Z, Benzel EC, Amin-Hanjani S, Barker FG 2nd, Harrington JF, Magge SN, Strugar J, Coumans JV, Borges LF (2004) Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative Grade I spondylolisthesis. J Neurosurg Spine 1(3):267–272. doi:10.3171/spi.2004.1.3.0267 CrossRefPubMed

Okuda S, Oda T, Miyauchi A, Haku T, Yamamoto T, Iwasaki M (2007) Surgical outcomes of posterior lumbar interbody fusion in elderly patients. Surgical technique. J Bone Jt Surg Am 89(Suppl 2 Pt.2):310–320. doi:10.2106/jbjs.g.00307

Chang HS, Fujisawa N, Tsuchiya T, Oya S, Matsui T (2014) Degenerative spondylolisthesis does not affect the outcome of unilateral laminotomy with bilateral decompression in patients with lumbar stenosis. Spine (Phila Pa 1976) 39(5):400–408. doi:10.1097/brs.0000000000000161 CrossRef

Inui T, Murakami M, Nagao N, Miyazaki K, Matsuda K, Tominaga Y, Kitano M, Hasegawa H, Tominaga S (2016) Lumbar degenerative spondylolisthesis: changes in surgical indications and comparison of instrumented fusion with two surgical decompression procedures. Spine (Phila Pa 1976) 42(1):E15–E24. doi:10.1097/BRS.0000000000001688 CrossRef

Austevoll IM, Gjestad R, Brox JI, Solberg TK, Storheim K, Rekeland F, Hermansen E, Indrekvam K, Hellum C (2016) The effectiveness of decompression alone compared with additional fusion for lumbar spinal stenosis with degenerative spondylolisthesis: a pragmatic comparative non-inferiority observational study from the Norwegian Registry for Spine Surgery. Eur Spine J 26(2):404–413CrossRefPubMed

Rampersaud YR, Fisher C, Yee A, Dvorak MF, Finkelstein J, Wai E, Abraham E, Lewis SJ, Alexander D, Oxner W (2014) Health-related quality of life following decompression compared to decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian multicentre study. Can J Surg 57(4):E126–E133CrossRefPubMedPubMedCentral

10.

Forsth P, Michaelsson K, Sanden B (2013) Does fusion improve the outcome after decompressive surgery for lumbar spinal stenosis? A two-year follow-up study involving 5390 patients. Bone Jt J 95-B(7):960–965. doi:10.1302/0301-620x.95b7.30776 CrossRef

11.

Park JH, Hyun SJ, Roh SW, Rhim SC (2012) A comparison of unilateral laminectomy with bilateral decompression and fusion surgery in the treatment of grade I lumbar degenerative spondylolisthesis. Acta Neurochir (Wien) 154(7):1205–1212CrossRef

12.

Kim S, Mortaz Hedjri S, Coyte PC, Rampersaud YR (2012) Cost-utility of lumbar decompression with or without fusion for patients with symptomatic degenerative lumbar spondylolisthesis. Spine J 12(1):44–54CrossRefPubMed

13.

Ghogawala Z, Dziura J, Butler WE, Dai F, Terrin N, Magge SN, Coumans JV, Harrington JF, Amin-Hanjani S, Schwartz JS, Sonntag VK, Barker FG, Benzel EC (2016) Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med 374(15):1424–1434. doi:10.1056/NEJMoa1508788 CrossRefPubMed

14.

Forsth P, Ólafsson G, Carlsson T, Frost A, Borgstrm F, Fritzell P, Ohagen P, Michalsson K, Sandén B (2016) A Randomized, Controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med 374(15):1413–1423CrossRefPubMed

15.

Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JA (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928CrossRefPubMedPubMedCentral

16.

Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605CrossRefPubMed

17.

Bridwell KH, Sedgewick TA, O’Brien MF, Lenke LG, Baldus C (1993) The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord 6(6):461–472CrossRefPubMed

18.

Herkowitz HN, Kurz LT (1991) Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Jt Surg Am 73(6):802–808CrossRef

19.

Alvin MD, Lubelski D, Abdullah KG, Whitmore RG, Benzel EC, Mroz TE (2016) Cost-utility analysis of instrumented fusion versus decompression alone for Grade I L4–L5 spondylolisthesis at 1-year follow-up. Clin Spine Surg 29(2):E80–E86PubMed

20.

Sigmundsson FG, Jonsson B, Stromqvist B (2015) Outcome of decompression with and without fusion in spinal stenosis with degenerative spondylolisthesis in relation to preoperative pain pattern: a register study of 1,624 patients. Spine J 15(4):638–646. doi:10.1016/j.spinee.2014.11.020 CrossRefPubMed

21.

Kleinstueck FS, Fekete TF, Mannion AF, Grob D, Porchet F, Mutter U, Jeszenszky D (2012) To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer? Eur Spine J 21(2):268–275CrossRefPubMed

22.

Matsudaira K, Yamazaki T, Seichi A, Takeshita K, Hoshi K, Kishimoto J, Nakamura K (2005) Spinal stenosis in grade I degenerative lumbar spondylolisthesis: a comparative study of outcomes following laminoplasty and laminectomy with instrumented spinal fusion. J Orthop Sci 10(3):270–276CrossRefPubMed

23.

Yone K, Sakou T, Kawauchi Y, Yamaguchi M, Yanase M (1996) Indication of fusion for lumbar spinal stenosis in elderly patients and its significance. Spine (Phila Pa 1976) 21(2):242–248CrossRef

24.

Feffer HL, Wiesel SW, Cuckler JM, Rothman RH (1985) Degenerative spondylolisthesis: to fuse or not to fuse. Spine (Phila Pa 1976) 10(3):287–289CrossRef

25.

Fox MW, Onofrio BM, Onofrio BM, Hanssen AD (1996) Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone. J Neurosurg 85(5):793–802. doi:10.3171/jns.1996.85.5.0793 CrossRefPubMed

26.

Resnick DK, Watters WC 3rd, Sharan A, Mummaneni PV, Dailey AT, Wang JC, Choudhri TF, Eck J, Ghogawala Z, Groff MW, Dhall SS, Kaiser MG (2014) Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9: lumbar fusion for stenosis with spondylolisthesis. J Neurosurg Spine 21(1):54–61. doi:10.3171/2014.4.spine14274 CrossRefPubMed

27.

Johnsson KE, Redlund-Johnell I, Uden A, Willner S (1989) Preoperative and postoperative instability in lumbar spinal stenosis. Spine (Phila Pa 1976) 14(6):591–593CrossRef

28.

Martin CR, Gruszczynski AT, Braunsfurth HA, Fallatah SM, O’neil J, Wai EK (2007) The surgical management of degenerative lumbar spondylolisthesis: a systematic review. Spine (Phila Pa 1976) 32(16):1791–1798CrossRef

29.

Steiger F, Becker H-J, Standaert C, Balague F, Vader J-P, Porchet F, Mannion A (2014) Surgery in lumbar degenerative spondylolisthesis: indications, outcomes and complications. A systematic review. Eur Spine J 23(5):945–973CrossRefPubMed

30.

Mardjetko S, Connolly P, Shott S (1994) Degenerative lumbar spondylolisthesis: a meta-analysis of literature 1970–1993. Spine (Phila Pa 1976) 19(20):2256S–2265SCrossRef

31.

Booth KC, Bridwell KH, Eisenberg BA, Baldus CR, Lenke LG (1999) Minimum 5-year results of degenerative spondylolisthesis treated with decompression and instrumented posterior fusion. Spine 24(16):1721CrossRefPubMed

32.

Herkowitz HN (1995) Degenerative lumbar spondylolisthesis. Spine (Phila Pa 1976) 20(9):1084–1090CrossRef

33.

Matsunaga S, Sakou T, Morizono Y, Masuda A, Demirtas AM (1990) Natural history of degenerative spondylolisthesis: pathogenesis and natural course of the slippage. Spine (Phila Pa 1976) 15(11):1204–1210CrossRef

34.

Nork SE, Hu SS, Workman KL, Glazer PA, Bradford DS (1999) Patient outcomes after decompression and instrumented posterior spinal fusion for degenerative spondylolisthesis. Spine (Phila Pa 1976) 24(6):561–569CrossRef

35.

Konno S, Kikuchi S (2000) Prospective study of surgical treatment of degenerative spondylolisthesis: comparison between decompression alone and decompression with graf system stabilization. Spine (Phila Pa 1976) 25(12):1533–1537CrossRef

36.

Lombardi JS, Wiltse LL, Reynolds J (1985) Treatment of degenerative spondylolisthesis. Spine (Phila Pa 1976) 10(9):821–827CrossRef

37.

Kristof RA, Aliashkevich AF, Schuster M, Meyer B, Urbach H, Schramm J (2002) Degenerative lumbar spondylolisthesis-induced radicular compression: nonfusion-related decompression in selected patients without hypermobility on flexion-extension radiographs. J Neurosurg 97(3 Suppl):281–286PubMed

38.

Blumenthal C, Curran J, Benzel EC, Potter R, Magge SN, Harrington JF Jr, Coumans JV, Ghogawala Z (2013) Radiographic predictors of delayed instability following decompression without fusion for degenerative grade I lumbar spondylolisthesis. J Neurosurg Spine 18(4):340–346CrossRefPubMed

39.

Barrey C, Jund J, Noseda O, Roussouly P (2007) Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J 16(9):1459–1467. doi:10.1007/s00586-006-0294-6 CrossRefPubMedPubMedCentral

40.

Barrey C, Jund J, Perrin G, Roussouly P (2007) Spinopelvic alignment of patients with degenerative spondylolisthesis. Neurosurgery 61(5):981–986CrossRefPubMed

41.

Gille O, Challier V, Parent H, Cavagna R, Poignard A, Faline A, Fuentes S, Ricart O, Ferrero E, Ould Slimane M (2014) Degenerative lumbar spondylolisthesis: cohort of 670 patients, and proposal of a new classification. Orthop Traumatol Surg Res 100(6 Suppl):S311–S315CrossRefPubMed

42.

Lee SH, Lee JH, Hong SW, Chung SE, Yoo SH, Lee HY (2010) Spinopelvic alignment after interspinous soft stabilization with a tension band system in grade 1 degenerative lumbar spondylolisthesis. Spine (Phila Pa 1976) 35(15):E691–E701. doi:10.1097/BRS.0b013e3181d2607e CrossRef

43.

Hammerberg KW (2005) New concepts on the pathogenesis and classification of spondylolisthesis. Spine (Phila Pa 1976) 30(6 Suppl):S4–S11CrossRef

44.

Bourghli A, Aunoble S, Reebye O, Le Huec JC (2011) Correlation of clinical outcome and spinopelvic sagittal alignment after surgical treatment of low-grade isthmic spondylolisthesis. Eur Spine J 20(5 Suppl):663–668. doi:10.1007/s00586-011-1934-z CrossRefPubMedPubMedCentral

45.

Mannion AF, Denzler R, Dvorak J, Grob D (2010) Five-year outcome of surgical decompression of the lumbar spine without fusion. Eur Spine J 19(11):1883–1891CrossRefPubMedPubMedCentral

46.

Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG (2010) Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 303(13):1259–1265CrossRefPubMedPubMedCentral

47.

Alimi M, Hofstetter CP, Pyo SY, Paulo D, Härtl R (2015) Minimally invasive laminectomy for lumbar spinal stenosis in patients with and without preoperative spondylolisthesis: clinical outcome and reoperation rates. J Neurosurg Spine 22(4):339–352CrossRefPubMed

48.

Gibson JNA, Waddell G (2005) Surgery for degenerative lumbar spondylosis: updated cochrane review. Spine (Phila Pa 1976) 30(20):2312–2320CrossRef

49.

Egger M, Ebrahim S, Smith GD (2002) Where now for meta-analysis? Int J Epidemiol 31:1–5CrossRefPubMed

50.

Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso-Coello P, Rind D, Devereaux P, Montori VM, Freyschuss B, Vist G (2011) GRADE guidelines 6. Rating the quality of evidence—imprecision. J Clin Epidemiol 64(12):1283–1293CrossRefPubMed

Title: Decompression plus fusion versus decompression alone for degenerative lumbar spondylolisthesis: a systematic review and meta-analysis
Authors: Hai-Feng Liang
Shu-Hao Liu
Zi-Xian Chen
Qin-Ming Fei
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 12/2017
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-017-5200-x

At a glance: The STEP trials

Springer Medicine

Decompression plus fusion versus decompression alone for degenerative lumbar spondylolisthesis: a systematic review and meta-analysis

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2017

Circumferential fusion for degenerative lumbar spondylolisthesis complicated by distal junctional grade 4 spondylolisthesis in the sub-acute post-operative setting

First clinical results of minimally invasive vector lumbar interbody fusion (MIS-VLIF) in spondylodiscitis and concomitant osteoporosis: a technical note

Is decompressive surgery the only treatment option? A case series of patients with spinal tuberculosis in advanced pregnancy

Relationship between preoperative serum rapid turnover proteins and early-stage surgical wound infection after spine surgery

Modification of PMMA vertebroplasty cement for reduced stiffness by addition of normal saline: a material properties evaluation

Minimally invasive spine surgery in lumbar spondylodiscitis: a retrospective single-center analysis of 67 cases