| Autor: |
Gagliardi MJ; Department of Neurosurgery, 10071St Michael's Hospital, University of Toronto, Toronto, ON, Canada.; Department of Orthopedics, Hospital Español de Mendoza, Mendoza, Argentina., Guiroy AJ; Department of Orthopedics, Hospital Español de Mendoza, Mendoza, Argentina.; The Paley Orthopedics and Spine Institute, Saint Mary's Medical Center, West Palm Beach, FL, USA., Camino-Willhuber G; UCI Medical Centre, 8788University of California, Oakland, CA, USA., Joaquim AF; Department of Neurosurgery, 28132University of Campinas, Campinas, Brazil., Carazzo CA; Department of Neurosurgery, São Vicente de Paulo Hospital, 488738University of Passo Fundo, Passo Fundo, Brazil., Yasuda E; Department of Neurosurgery, Hospital de Clinicas, University of Buenos Aires, Buenos Aires, Argentina., Cabrera JP; Department of Neurosurgery, Hospital Clinico Regional de Concepción, Concepción, Chile., Morales Ciancio AR; Department of Orthopedics, Hospital Español de Mendoza, Mendoza, Argentina.; Department of Orthopaedics, 4956Great Ormond Street Hospital, London, UK. |
| Abstrakt: |
Study design: Systematic Review and Meta-analysis. Objective: Surgical alternatives to treat lumbar spinal stenosis and instability include indirect (ALIF, OLIF, and LLIF) and direct (TLIF or posterior lumbar interbody fusion) decompression and fusion interventions. Although both approaches have proven to be effective in reducing symptoms, it is unknown if there is any difference in effectiveness between them. In this systematic review and meta-analysis, we aimed to evaluate postoperative pain and disability in patients treated whit indirect vs direct decompression and fusion approaches. Methods: We conducted a systematic review of the literature consulting several databases and identified studies that enrolled patients diagnosed with degenerative lumbar spinal stenosis and instability treated with indirect or direct decompression and fusion techniques. Our primary endpoints were the visual analogue scale, Oswestry Disability Index, and the Japanese Orthopedics Association Back Pain Evaluation Questionnaire 1 year after the procedure. Secondary outcomes included complication rate, blood loss, and surgical time. Results: Nine retrospective and comparative studies were included enrolling a total of 1004 participants. Both surgical strategies had satisfactory clinical outcomes with no significant difference at 1 year. Although the complication rate was similar for both groups, the profile of the adverse events was different. In addition, patients treated with indirect decompression and fusion had significantly less blood loss and operative times. Conclusions: Indirect and direct decompression and fusion techniques are similarly effective in treating patients with lumbar spinal stenosis and instability. The ID group had significantly lower intraoperative blood loss and surgical time values. |
