Background:

This systematic review and meta-analysis were performed to investigate evidence for the comparison of lumbar dynamic stabilization device Coflex with posterior lumbar fusion for lumbar spinal stenosis (LSS).

Methods:

Relational databases were searched to October 2022. The main outcome measures included operation time, Japanese Orthopedic Association (JOA), visual analog scale (VAS), oswestry disability index (ODI), total complications, and adjacent segment degeneration (ASD). Statistical analysis was performed with Review Manager 5.3 (Cochrane Collaboration).

Results:

A total of 26 studies were included. The main results of this meta-analysis showed lumbar dynamic stabilization device Coflex had shorter operation time (MD = -50.77 min, 95%CI：-57.24∼-44.30, P<0.00001), less intraoperative blood loss (MD= -122.21 ml, 95%CI：-129.68∼-94.74, P<0.00001), and shorter hospital stays (MD= -3.21 day, 95%CI：-4.04∼-2.37, P<0.00001). What's more, the JOA score and ODI score were higher in Coflex group during early follow-up. Yet, there was no significant difference between the two groups with the extension of follow-up time. Moreover, the Coflex group had a lower VAS score than fusion treatment (P<0.00001). Finally, the Coflex group had lower total complications rate (P=0.03), lower ASD rate (P=0.001), and higher ROM (P<0.00001), but there was no significant difference in reoperation rate and internal fixation problems rate.

Conclusion:

Current evidence suggests that lumbar dynamic stabilization device Coflex are superior to posterior lumbar fusion in early follow-up. However, considering that dynamic stabilization device group also has its limitations, so these findings need to be further verified by multi-center, double-blind, and large sample RCTs.