Study design:

Systematic Review and Meta Analysis.

Objective:

To compare outcomes and complications profile of laminectomy alone versus laminectomy and fusion for the treatment of degenerative lumbar spondylolisthesis (DLS).

Summary of background data:

Degenerative lumbar spondylolisthesis is a common cause of back pain and functional impairment. DLS is associated with high monetary (up to $100 billion annually in the USA) and non-monetary societal and personal costs. While non-operative management remains first-line treatment for DLS, decompressive laminectomy with or without fusion is indicated for treatment-resistant disease.

Methods:

We systematically searched PubMed and EMBASE for RCTs and cohort studies from inception through April 14th, 2022. Data was pooled using random-effects meta-analysis. Risk of bias was assessed using the Joanna Briggs Institute risk of bias tool3,4. We generated odds ratio and standard mean difference estimates for select parameters.

Results:

A total of 23 manuscripts were included (n=90,996 patients). Complication rates were higher in patients undergoing laminectomy and fusion compared to laminectomy alone (OR: 1.55, P<0.001). Rates of reoperation were similar between both groups (OR: 0.67, P=0.10). Laminectomy with fusion was associated with a longer duration of surgery (Standard Mean Difference: 2.60, P=0.04) and longer hospital stay (2.16, P=0.01). Compared to laminectomy alone, the extent of functional improvement in pain and disability was superior in the laminectomy and fusion cohort. Laminectomy with fusion had a greater mean change in ODI (-0.38, P<0.01) compared to laminectomy alone. Laminectomy with fusion was associated with a greater mean change in NRS leg score (-0.11, P=0.04) and NRS back score (-0.45, P<0.01).

Conclusion:

Compared to laminectomy alone, laminectomy with fusion is associated with greater postoperative improvement in pain and disability, albeit with a longer duration of surgery and hospital stay.