Medical student Trinity School of Medicine, Saint Vincent and Grenadines
Disclosure(s):
Tirath Patel, Medical student: No financial relationships to disclose
Introduction: Lumbar spinal stenosis (LSS) is a degenerative condition affecting more than 20,000 persons in the United States and is a common referral for surgery in geriatric patients. Open decompression surgery (ODS) has been the traditional treatment, but it is associated with significant adverse effects. Recently, minimally invasive surgery (MIS) has emerged as an alternative, with fewer adverse effects. This meta-analysis compares the outcomes of open surgery vs MIS for LSS, focusing on functional status, central canal stenosis, postoperative complications, and pain control.
Methods: Following PRISMA guidelines, randomized controlled trials (RCTs), cohort, and case-control studies which compared MIS with ODS with a minimum two-year follow-up were included. A comprehensive search was conducted using PubMed, Pubmed Central, and MEDLINE, yielding 9 studies that met the inclusion criteria. Data was extracted by two independent authors, and RevMan was used for statistical analysis.
Results: No significant differences were found between MIS and ODS in functional status in pre-operative [MD = -0.10, 95% CI (-0.72 to 0.52)] and three months post-operative [MD = -0.99, 95% CI (-4.31 to 2.33)]. However, at one-year, significantly fewer postoperative complications were associated with MIS [MD = -1.36, 95% CI (-2.03 to -0.70); risk ratio = 0.45 (95% CI, 0.22–0.92; p = 0.03].
Conclusion : Meta-analysis of RCTs demonstrates that minimally invasive surgery for lumbar spinal stenosis is associated with improvements in functional status one year after surgery. This finding is based on significantly fewer postoperative complications compared to traditional open decompression surgery. However, the long-term outcomes, particularly pain control and functional recovery, require further investigation, highlighting the need for future research.
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