• Geet G Shukla, Sai S Chilakapati, Abhijith V Matur, Paolo Palmisciano, Fatu Conteh, Louisa Onyewadume, Henry Duah, Azante Griffith, Xu Tao, Phillip Vorster, Sahil Gupta, Joseph Cheng, Benjamin Motley, and Owoicho Adogwa.
• Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH.
• Spine. 2023 Jun 15; 48 (12): 874884874-884.

Study DesignSystematic review and Meta-analysis.ObjectiveTo compare outcomes and complications profile of laminectomy alone versus laminectomy and fusion for the treatment of degenerative lumbar spondylolisthesis (DLS).Summary Of Background DataDegenerative 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 US) and nonmonetary societal and personal costs. While nonoperative management remains the first-line treatment for DLS, decompressive laminectomy with or without fusion is indicated for the treatment-resistant disease.MethodsWe systematically searched PubMed and EMBASE for RCTs and cohort studies from inception through April 14, 2022. Data were pooled using random-effects meta-analysis. The risk of bias was assessed using the Joanna Briggs Institute risk of bias tool. We generated odds ratio and standard mean difference estimates for select parameters.ResultsA total of 23 manuscripts were included (n=90,996 patients). Complication rates were higher in patients undergoing laminectomy and fusion compared with 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 a longer hospital stay (2.16, P =0.01). Compared with 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 with 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).ConclusionCompared with 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.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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