Laminectomy with Fusion Is Associated with Greater Functional Improvement Compared with Laminectomy Alone for Treatment of Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-analysis

Introduction: Degenerative lumbar spondylolisthesis (DLS) is a common cause of back pain and functional impairment. Surgical treatment of DLS involves decompressive laminectomy with or without fusion for treatment-resistant disease. We therefore performed a systematic review and meta analysis to compare outcomes and complications profile of laminectomy alone versus laminectomy and fusion for the treatment of DLS.

Methods: PubMed and EMBASE was searched according to PRISMA criteria for prospective trials and retrospective cohort studies from inception through April 14th, 2022. Information was extracted on study design, quality, bias, participants, and outcomes. Data was pooled using random-effects meta-analysis. Outcomes were expressed as odds ratios (OR) or standard mean difference (SMD).

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 (SMD 2.60, P = 0.04) and longer hospital stay (SMD 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 (SMD -0.38, P < 0.01) compared to laminectomy alone. Laminectomy with fusion was associated with a greater mean change in NRS leg score (SMD -0.11, P = 0.04) and NRS back score (SMD -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 greater risk of complications, longer hospital stay, and longer operation time. Future studies should aim to explore this tradeoff further in order to optimize outcomes for patients with DLS.