• Yansong Ge, Yaoxing Lu, Cheng Ma, Benteng Lu, Erteng Ma, Yafei Zhang, and Fei Zhao.
• Department of Spine and Orthopaedics, Wuhu Hospital of Traditional Chinese Medicine Affiliated to Anhui University of Traditional Chinese Medicine, Wuhu Anhui 241000, China.
• World Neurosurg. 2024 Nov 20.

BackgroundSurgery is the preferred option for lumbar spinal stenosis (LSS) when conservative methods cannot meet the needs. Recent advancements in surgical techniques have brought various new methods for treating LSS.MethodFour databases, PubMed, Embase, the Cochrane Library, and Web of Science, were searched, covering the period from the establishment of the databases until May 2024. Randomized controlled trials (RCTs) were carried out to treat LSS using different surgical approaches. The outcome measures included the visual analogue scale (VAS) score, Oswestry disability index (ODI) score, surgical duration, intraoperative blood loss, and length of hospital stay of patients. Bayesian random-effects network meta-analysis (NMA) was performed using R software (V4.4) and STATA17.0 software to analyze each surgical approach.ResultsA total of 29 studies involving 4,200 patients were included. Nine intervention methods, including laminotomy, decompression, decompression plus fusion (DPF), endoscopic decompression, interspinous process spacer device (IPSD), laminectomy, minimally invasive decompression (MID), spinous process osteotomy (SPO), and lumbar interbody fusion (LIF), were analyzed. NMA results indicated that endoscopic decompression (SUCRA=88.70%) was the most effective in reducing short-term back VAS scores. IPSD (SUCRA=98.00%) was the most effective in reducing long-term back VAS scores, surgical duration (SUCRA=95.20%), and intraoperative blood loss (SUCRA=100.00%). Endoscopic decompression (SUCRA=83.60%) also showed the most significant effect in reducing hospital stays.ConclusionEndoscopic decompression can effectively improve short-term back VAS scores and reduce hospital stays, while IPSD is effective in reducing long-term back VAS scores with minimal surgical duration and blood loss.Copyright © 2024. Published by Elsevier Inc.

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