Archives of Orthopaedic and Trauma Surgery

, Volume 137, Issue 5, pp 637–650 | Cite as

Effectiveness of decompression alone versus decompression plus fusion for lumbar spinal stenosis: a systematic review and meta-analysis

  • Wenli Chang
  • Peizhi Yuwen
  • Yanbing Zhu
  • Ning Wei
  • Chen Feng
  • Yingze Zhang
  • Wei Chen
Orthopaedic Surgery



The debate on efficacy of fusion added to decompression for lumbar spinal stenosis (LSS) is ongoing. No meta-analysis has compared the effectiveness of decompression versus decompression plus fusion in treating patients with LSS.


A literature search was performed in the Web of Science, PubMed, Embase, and Springer databases from 1970 to 2016. Relevant references were selected and the included studies were manually reviewed. We included trials evaluating decompression surgery compared to decompression plus fusion surgery in treating patients with LSS. The primary outcomes analyzed were back pain, leg pain, Oswestry Disability Index scores (ODI), the quality-of-life EuroQol-5 Dimensions (EQ-5D), duration of operation, intraoperative blood loss, length of hospital stay, major complications, walking ability, number of reoperation, and finally clinically excellent and good rates. Data analysis was conducted using the Review Manager 5.2 software.


Fifteen studies involving 17,785 patients with LSS were included. The overall effect mean difference (MD) (95% CI) in the differences between pre- and post-operative back pain, leg pain, operative time, intraoperative blood loss, and length of stay were 0.04 (−0.36, 0.44), 0.69 (−0.38, 1.76), −2.04 (−3.12, −0.96), −3.96 (−6.64, −1.27) and −4.21 (−10.03, 1.62) (z = 0.18, 1.26, 3.71, 2.89 and 1.41, respectively; P = 0.86, 0.55, 0.0002, 0.004 and 0.16, respectively) in random effects models. The overall effect MD (95% CI) in ODI, EQ-5D, and walking ability were 0.43 (−1.15, 2.00), 0.01 (−0.01, 0.03) and 0.04 (−0.49, 0.57) (z = 0.52, 1.16 and 0.15, respectively; P = 0.59, 0.24 and 0.88, respectively) in fixed effects models. The overall effect odds ratio (OR) (95% CI) of major complications, number of reoperations, and clinically excellent and good rates between the two groups were 0.70 (0.60, 0.81), 1.04 (0.90, 1.19) and 0.31 (0.06, 1.59) (z = 4.63, 0.53 and 1.40, respectively; P < 0.00001, 0.60 and 0.16, respectively). Our study reveals no difference in the effectiveness between the two surgical techniques.


The additional fusion in the management of LSS yielded no clinical improvements over decompression alone within a 2-year follow-up period. But fusion resulted in a longer duration of operation, more blood loss, and a higher risk of complications. Therefore, the appropriate surgical protocol for LSS should be discussed further.


Lumbar spinal stenosis Degenerative spondylolisthesis Decompression Fusion Meta-analysis 


JOA score

Japanese Orthopaedic Association scoring system


Lumbar spinal stenosis


Degenerative spondylolisthesis


Mean difference


Odd ratio


Lumbar degenerative diseases


Oswestry Disability Index scores


The quality-of-life EuroQol-5 Dimensions


Randomized, controlled trial


Visual analogue score


The classic Newcastle–Ottawa Scale


Unilateral laminotomy with bilateral decompression


Low back pain


Degenerative disc disease


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Verbiest H (1955) Further experiences on the pathological influence of a developmental narrowness of the bony lumbar vertebral canal. J Bone Jt Surg Br 37:576–583Google Scholar
  2. 2.
    Wiltse LL, Kirkaldy-Willis W, McIvor G (1976) The treatment of spinal stenosis. Clin Orthop Relat Res 115:83–91Google Scholar
  3. 3.
    Verbiest H (1977) Results of surgical treatment of idiopathic developmental stenosis of the lumbar vertebral canal. A review of twenty-seven years’ experience. J Bone Jt Surg Br 59:181–188Google Scholar
  4. 4.
    Grabias S (1980) Current concepts review. The treatment of spinal stenosis. J Bone Jt Surg Am 62:308–313CrossRefGoogle Scholar
  5. 5.
    Machado GC, Ferreira PH, Harris IA et al (2015) Effectiveness of surgery for lumbar spinal stenosis: a systematic review and meta-analysis. PLoS One 10:e0122800CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Chang HS, Fujisawa N, Tsuchiya T et al (2014) Degenerative spondylolisthesis does not affect the outcome of unilateral laminotomy with bilateral decompression in patients with lumbar stenosis. Spine 39:400–408CrossRefPubMedGoogle Scholar
  7. 7.
    Mardjetko S, Connolly P, Shott S (1994) Degenerative lumbar spondylolisthesis: a meta-analysis of literature 1970–1993. Spine 19:2256–2265CrossRefGoogle Scholar
  8. 8.
    Carreon LY, Puno RM, Dimar JR 2nd et al (2003) Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Jt Surg Am 85:2089–2092CrossRefGoogle Scholar
  9. 9.
    Glassman SD, Carreon LY, Dimar JR et al (2007) Clinical outcomes in older patients after posterolateral lumbar fusion. Spine J 7:547–551CrossRefPubMedGoogle Scholar
  10. 10.
    Cassinelli EH, Eubanks J, Vogt M et al (2007) Risk factors for the development of perioperative complications in elderly patients undergoing lumbar decompression and arthrodesis for spinal stenosis: an analysis of 166 patients. Spine 32:230–235CrossRefPubMedGoogle Scholar
  11. 11.
    Raffo CS, Lauerman WC (2006) Predicting morbidity and mortality of lumbar spine arthrodesis in patients in their ninth decade. Spine 31:99–103CrossRefPubMedGoogle Scholar
  12. 12.
    Nasca RJ (1989) Rationale for spinal fusion in lumbar spinal stenosis. Spine 14:451–454CrossRefPubMedGoogle Scholar
  13. 13.
    Johnsson K-E, Redlund-Johnell I, Uden A et al (1989) Preoperative and postoperative instability in lumbar spinal stenosis. Spine 14:591–593CrossRefPubMedGoogle Scholar
  14. 14.
    Getty C, Kirwan E, Sullivan M (1981) Partial undercutting facetectomy for bony entrapment of the lumbar nerve root. J Bone Jt Surg Br 63:330–335Google Scholar
  15. 15.
    Gelalis ID, Arnaoutoglou C, Christoforou G et al (2010) Prospective analysis of surgical outcomes in patients undergoing decompressive laminectomy and posterior instrumentation for degenerative lumbar spinal stenosis. Acta Orthop Traumatol Turc 44:235–240CrossRefPubMedGoogle Scholar
  16. 16.
    Grobler LJ, Robertson PA, Novotny JE et al (1993) Decompression for degenerative spondylolisthesis and spinal stenosis at L4–5: the effects on facet joint morphology. Spine 18:1475–1482CrossRefPubMedGoogle Scholar
  17. 17.
    Ghogawala Z, Dziura J, Butler WE et al (2016) Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med 374:1424–1434CrossRefPubMedGoogle Scholar
  18. 18.
    Forsth P, Olafsson G, Carlsson T et al (2016) A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med 374:1413–1423CrossRefPubMedGoogle Scholar
  19. 19.
    Hansraj KK, O’Leary PF, Cammisa FP Jr et al (2001) Decompression, fusion, and instrumentation surgery for complex lumbar spinal stenosis. Clin Orthop Relat Res 384:18–25CrossRefGoogle Scholar
  20. 20.
    Transfeldt EE, Topp R, Mehbod AA et al (2010) Surgical outcomes of decompression, decompression with limited fusion, and decompression with full curve fusion for degenerative scoliosis with radiculopathy. Spine 35:1872–1875CrossRefPubMedGoogle Scholar
  21. 21.
    Amundsen T, Weber H, Nordal HJ et al (2000) Lumbar spinal stenosis: conservative or surgical management?: a prospective 10-year study. Spine 25:1424–1436CrossRefPubMedGoogle Scholar
  22. 22.
    Burgstaller JM, Porchet F, Steurer J et al (2015) Arguments for the choice of surgical treatments in patients with lumbar spinal stenosis—a systematic appraisal of randomized controlled trials. BMC Musculoskelet Disord 16:1CrossRefGoogle Scholar
  23. 23.
    Yone K, Sakou T, Kawauchi Y et al (1996) Indication of fusion for lumbar spinal stenosis in elderly patients and its significance. Spine 21:242–248CrossRefPubMedGoogle Scholar
  24. 24.
    Herkowitz H, Kurz L (1991) Degenerative lumbar spondylolisthesis with spinal stenosis. J Bone Jt Surg 73:802–808CrossRefGoogle Scholar
  25. 25.
    Harms J, Rolinger H (1981) A one-stager procedure in operative treatment of spondylolistheses: dorsal traction-reposition and anterior fusion. Z Orthop Ihre Grenzgeb 120:343–347CrossRefGoogle Scholar
  26. 26.
    Suk S-I, Lee C-K, Kim W-J et al (1997) Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine 22:210–219CrossRefPubMedGoogle Scholar
  27. 27.
    Kleinstueck F, Fekete T, Mannion A et al (2012) To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer? Eur Spine J 21:268–275CrossRefPubMedGoogle Scholar
  28. 28.
    Martin CR, Gruszczynski AT, Braunsfurth HA et al (2007) The surgical management of degenerative lumbar spondylolisthesis: a systematic review. Spine 32:1791–1798CrossRefPubMedGoogle Scholar
  29. 29.
    Lawhorne TW III, Girardi FP, Mina CA et al (2009) Treatment of degenerative spondylolisthesis: potential impact of dynamic stabilization based on imaging analysis. Eur Spine J 18:815–822CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Ekman P, Moller H, Shalabi A et al (2009) A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration. Eur Spine J 18:1175–1186CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Hallett A, Huntley JS, Gibson JN (2007) Foraminal stenosis and single-level degenerative disc disease: a randomized controlled trial comparing decompression with decompression and instrumented fusion. Spine 32:1375–1380CrossRefPubMedGoogle Scholar
  32. 32.
    Dailey A, Harrop JS, France JC (2010) High-energy contact sports and cervical spine neuropraxia injuries: what are the criteria for return to participation? Spine 35:S193–S201CrossRefPubMedGoogle Scholar
  33. 33.
    Brodke DS, Annis P, Lawrence BD et al (2013) Reoperation and revision rates of 3 surgical treatment methods for lumbar stenosis associated with degenerative scoliosis and spondylolisthesis. Spine 38:2287–2294CrossRefPubMedGoogle Scholar
  34. 34.
    McCullen GM, Bernini PM, Bernstein SH et al (1994) Clinical and roentgenographic results of decompression for lumbar spinal stenosis. J Spinal Disord 7:380–387CrossRefPubMedGoogle Scholar
  35. 35.
    Brown MD, Wehman KF, Heiner AD (2002) The clinical usefulness of intraoperative spinal stiffness measurements. Spine 27:959–961CrossRefPubMedGoogle Scholar
  36. 36.
    Matsudaira K, Yamazaki T, Seichi A et al (2005) Spinal stenosis in grade I degenerative lumbar spondylolisthesis: a comparative study of outcomes following laminoplasty and laminectomy with instrumented spinal fusion. J Orthop Sci 10:270–276CrossRefPubMedGoogle Scholar
  37. 37.
    Radcliff K, Curry P, Hilibrand A et al (2013) Risk for adjacent segment and same segment reoperation after surgery for lumbar stenosis: a subgroup analysis of the Spine Patient Outcomes Research Trial (SPORT). Spine 38:531CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Tuli SM, Kapoor V, Jain AK et al (2011) Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability. Indian J Orthop 45:396–403CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Munting E, Roder C, Sobottke R et al (2015) Patient outcomes after laminotomy, hemilaminectomy, laminectomy and laminectomy with instrumented fusion for spinal canal stenosis: a propensity score-based study from the Spine Tango registry. Eur Spine J 24:358–368CrossRefPubMedGoogle Scholar
  40. 40.
    Försth P, Michaëlsson K, Sandén B (2013) Does fusion improve the outcome after decompressive surgery for lumbar spinal stenosis? A two-year follow-up study involving 5390 patients. Bone Jt J 95:960–965CrossRefGoogle Scholar
  41. 41.
    Kleinstueck FS, Fekete TF, Mannion AF et al (2012) To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer? Eur Spine J 21:268–275CrossRefPubMedGoogle Scholar
  42. 42.
    Sigmundsson FG, Jonsson B, Stromqvist B (2015) Outcome of decompression with and without fusion in spinal stenosis with degenerative spondylolisthesis in relation to preoperative pain pattern: a register study of 1624 patients. Spine J 15:638–646CrossRefPubMedGoogle Scholar
  43. 43.
    Sigmundsson FG, Jonsson B, Stromqvist B (2014) Preoperative pain pattern predicts surgical outcome more than type of surgery in patients with central spinal stenosis without concomitant spondylolisthesis: a register study of 9051 patients. Spine 39:E199–E210CrossRefPubMedGoogle Scholar
  44. 44.
    Aihara T, Toyone T, Aoki Y et al (2012) Surgical management of degenerative lumbar spondylolisthesis: a comparative study of outcomes following decompression with fusion and microendoscopic decompression. J Musculoskelet Res 15:1250020CrossRefGoogle Scholar
  45. 45.
    Hu RW, Jaglal S, Axcell T et al (1997) A population-based study of reoperations after back surgery. Spine 22:2265–2270CrossRefPubMedGoogle Scholar
  46. 46.
    Lad SP, Babu R, Ugiliweneza B et al (2014) Surgery for spinal stenosis: long-term reoperation rates, health care cost, and impact of instrumentation. Spine 39(12):978–987CrossRefPubMedGoogle Scholar
  47. 47.
    Grob D, Humke T, Dvorak J (1995) Degenerative lumbar spinal stenosis. Decompression with and without arthrodesis. J Bone Jt Surg Am 77:1036–1041CrossRefGoogle Scholar
  48. 48.
    Postacchini F, Cinotti G (1992) Bone regrowth after surgical decompression for lumbar spinal stenosis. J Bone Jt Surg Br 74:862–869Google Scholar
  49. 49.
    Kim S, Mortaz Hedjri S, Coyte PC et al (2012) Cost-utility of lumbar decompression with or without fusion for patients with symptomatic degenerative lumbar spondylolisthesis. Spine J 12:44–54CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Wenli Chang
    • 1
  • Peizhi Yuwen
    • 1
  • Yanbing Zhu
    • 1
  • Ning Wei
    • 1
  • Chen Feng
    • 1
  • Yingze Zhang
    • 1
  • Wei Chen
    • 1
  1. 1.Department of Orthopedic SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangPeople’s Republic of China

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