Comparison Between Fusion and Non-Fusion Surgery for Lumbar Spinal Stenosis: A Meta-analysis

A large number of studies have shown that, for severe lumbar spinal stenosis, decompression surgery can often obtain better results than non-surgical treatment. However, whether the lumbar spine is fixed after decompression is still controversial. The results of biomechanical studies indicate that there is a correlation between the range of decompression and postoperative spinal instability. The multiple databases like Pubmed, Embase, Cochrane databases and China National Knowledge database were used to search for the relevant studies, and full-text articles involved in the evaluation of fusion and nonfusion surgery for lumbar spinal stenosis. Review Manager 5.2 was adopted to estimate the effects of the results among selected articles. Forest plots, sensitivity analysis and bias analysis for the articles included were also conducted. A total of nine relevant studies were eventually satisfied the included criteria. There were significant differences in length of stay [mean difference (MD) = 3.04, 95% CI (2.00, 4.08), P < 0.000]1), but there were no differences in Oswestry Disability Index (ODI score) [MD = − 1.14, 95% CI (− 2.92, 0.63), P = 0.21; I2 = 87%] and complications [RR = 1 with 95% CI (0.69, 1.46), P value of overall effect was 0.98]. The study was robust and limited publication bias was observed in this study. Our research supported that fusion and nonfusion surgeries had no differences in clinical effects and complications for lumbar spinal stenosis, while fusion surgery involved a longer length of stay than nonfusion surgery.