ABSTRACT
Objective A meta-analysis is to be performed to compare the entire efficacy on decompression (D) alone and decompression with fusion (F) for patients with 1-2 level lumbar stenosis (LSS) regardless of degenerative spandylolisthesis (DS) based on published RCTs.Methods The databases include Pubmed,Embase,Cochrane Library and Web of Science from January 1970 to March 2018 with a certain search strategy and inclusion criteria.Two reviewers assessed eligible trials,evaluated articles quality and extracted information independently and the information included basic characteristics of demographic information,primary and secondary measures,then data synthesis and meta-analysis was progressed as well as subgroup analysis by DS and follow-up time (36 months).Continuous variables were reported as weighted mean difference (WMD) and dichotomous variables were reported as odds ratios (ORs).Finally the strength of evidence and grade of recommendation was evaluated by the grades of recommendation,assessment,development and evaluation (GRADE) system for the overall outcome.Results A total of 9 RCTs with a low to moderate risk of bias met inclusion criteria with a total of 857 patients (367 were in D group and 490 were in F group) in 1-2 level operation and the average age,sex ratio and preoperative visual analogue scale (VAS) were of no significance.In primary measures,there were no statistical difference in VAS changes on back and leg pain between D and F group [MD=-0.03,95％ CI (--0.38,0.76),Z=0.08,P=0.94;MD=0.1 1,95％CI (-1.08,1.30),Z=0.18,P=0.86,respectively];Patients' satisfaction was of no difference between the two groups (OR=0.74,P=0.48),together with the change of Oswestry disability index (ODI,P=0.29) and European quality of life-5 dimensions (EQ-SD,P=0.41).As to the secondary measures,there were no difference in the rate of complication (OR=0.75,P=0.50) and reoperation (OR=1.93,P=0.11) while a statistical significance of longer operation duration (P=0.000),more blood loss (P=0.004),longer hospital stays (P=0.000) but amazing lower rate of ASD (OR=2.35,P=0.02) in F group.The subgroup analysis on whether combined with DS showed that basically all of the compared measures were in consistency with the whole meta-analysis;As to the follow-up,there was a higher reoperation rate in middle-to-long term (＞ 36months) in D group while the other measures were in line with the overall meta-analysis and adjacent segment degeneration/disease (ASD) was the most seasons of reoperation yet no matter the follow-up time.According to the GRADE system,the grade of this meta-analysis is of "High" quality.Conclusion F group has no better clinical results than D alone in short-segment LSS,regardless of DS,and even further,no significant change with shot-term or middle-to-long term follow-up.F approach has a longer duration of operation,more hospital stays and more blood loss,even perhaps a lager cost.According to the GRADE,the grade of this meta-analysis is of "High" quality,the grade strength of recommendation was "Strong".
ABSTRACT
Objective@#To review and compare radiological parameters between degenerative lumbar kyphoscoliosis (DLKS) and degenerative lumbar kyphosis (DLK), and analyze the relationships between coronal and sagittal deformities and compensatory mechanisms of sagittal balance.@*Methods@#A total of 82 patients with lumbar degenerative deformities were enrolled for our radiographic study at Department of Spinal Surgery, Peking University People′s Hospital from January 2016 to May 2017. These patients were divided into two groups: DLKS group (39 patients) with lumbar coronal and sagittal deformities, and DLK group (43 patients) just with lumbar sagittal deformity. Complete spinopelvic radiographic parameters were compared.@*Results@#The Cobb angle and lumbar lordosis of DLKS group were (23.0±11.8)° and (18.2±12.1)°, while the lumbar lordosis of DLK group was (20.4±10.2)°. In DLKS group, Cobb angle had correlations with lumbar lordosis(r=-0.338, P=0.035), and central sacral vertical line distance had significant correlations with thoracolumbar junctional angle (r=0.488, P=0.002) . Moreover, no significant differences of all sagittal spinopelvic parameters were found between two groups (P>0.05). In DLKS group, significant correlations between lumbar lordosis and sacral slope (r=0.617, P=0.000), and correlations between lumbar lordosis and thoracic kyphosis(r=-0.363, P=0.023) were observed. In DLK group, lumbar lordosis showed significant correlations with thoracic kyphosis(r=-0.341, P=0.025) and sacral slope (r=0.772, P=0.000). According to Nash-Moe grading scale of apical vertebral rotation, 10 patients were with Ⅰ-Ⅱ grade while 29 patients with Ⅲ-Ⅴ grade in DLKS group.@*Conclusions@#Both as typical lumbar degenerative deformities, there are some correlations between scoliosis and kyphosis. However, coronal scoliosis may not influent sagittal morphological parameters for DLKS patients. Thoracic curve changes and pelvic backtilt are both important for maintaining the sagittal balance in patients with degenerative lumbar kyphoscoliosis.