Laminectomy With Fusion is Associated With Greater Functional Improvement Compared With Laminectomy Alone for the Treatment of Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-Analysis

Authors

• Geet Shukla, University of Cincinnati College of Medicine
• Sai S. Chilakapati, University of Texas Southwestern Medical School
• Abhijith V. Matur, University of Cincinnati College of Medicine
• Paolo Palmisciano, University of Cincinnati College of Medicine
• Fatu Conteh, University of Cincinnati College of Medicine
• Louisa Onyewadume, University of Cincinnati College of Medicine
• Henry Ofori Duah, Marquette UniversityFollow
• Azante Griffith, University of Cincinnati College of Medicine
• Xu Tao, University of Cincinnati College of Medicine
• Phillip Vorster, University of Cincinnati College of Medicine
• Sahil Gupta, University of Cincinnati College of Medicine
• Joseph Cheng, University of Cincinnati College of Medicine
• Benjamin Motley, University of Cincinnati College of Medicine
• Owoicho Adogwa, University of Cincinnati College of Medicine

Document Type

Article

Publication Date

6-15-2023

Publisher

Lippincott Williams & Wilkins, Inc.

Source Publication

Spine

Source ISSN

0362-2436

Abstract

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 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. Methods.  We 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. Results.  A 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). Conclusion.  Compared 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.

Comments

Accepted version. Spine, Vol. 48, No. 12 (2023): 874-884. DOI. © 2023 Wolters Kluwer Health, Inc. Used with permission.

Henry Duah was affiliated with University of Cincinnati College of Medicine at the time of publication.

Recommended Citation

Shukla, Geet; Chilakapati, Sai S.; Matur, Abhijith V.; Palmisciano, Paolo; Conteh, Fatu; Onyewadume, Louisa; Duah, Henry Ofori; Griffith, Azante; Tao, Xu; Vorster, Phillip; Gupta, Sahil; Cheng, Joseph; Motley, Benjamin; and Adogwa, Owoicho, "Laminectomy With Fusion is Associated With Greater Functional Improvement Compared With Laminectomy Alone for the Treatment of Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-Analysis" (2023). College of Nursing Faculty Research and Publications. 1145.
https://epublications.marquette.edu/nursing_fac/1145