• Lin Liang, Wei-Min Jiang, Xue-Feng Li, and Heng Wang.
• Department of Orthopaedics, The First Affiliated Hospital of Soochow University 188 Shizi Street, Suzhou 215006, China.
• Int J Clin Exp Med. 2015 Jan 1; 8 (9): 14615-24.

PurposeThe surgical methods of degenerative lumbar spinal stenosis include spinal decompression with or without instrumented or non-instrumented spinal fusion. Previous meta-analysis and systematic reviews have reported the contrast between surgical management and nonsurgical management for degenerative lumbar spinal stenosis, while no literature did among surgical managements. And it is evidenced that whether fusion should be added to spinal decompression in patients of lumbar spinal stenosis is still divisive. So our purpose is to identify whether spinal fusion with or without decompression has a better effect than decompression alone for patients with degenerative lumbar spinal stenosis.MethodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) for reports before November 2014 and PubMed, EMBASE, GOOGLE SCHOLAR for those before December 2014. We also searched the reference lists included in studies and previous reviews. Randomized Controlled Trials and prospective or retrospective cohort studies of patients with degenerative lumbar spinal stenosis after spinal decompression with or without fusion were eligible. Abstracted outcomes from retrieved articles included clinical outcome and reoperation rate of two aspects. Both random-effects and fixed-effects models were used to calculate the end-points.ResultsWe identified 23 studies with data collected from 61576 patients. The combined relative risk (RR) of clinical outcome for the spinal fusion compared with the spinal decompression was 0.91 (95% confidence interval [CI]: 0.85 to 0.98), and little evidence of heterogeneity was observed. Namely, a satisfactory clinical outcome was significantly more likely with fusion than with decompression alone. But there was a trend toward a higher reoperation rate with fusion compared with decompression alone (RR: 0.93; 95% CI: 0.88 to 0.97).ConclusionThis meta-analysis provides robust evidence of a better clinical outcome but a higher reoperation rate for spinal fusion compared with decompression alone.

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