medical student UCLA Mountain House, California, United States
Introduction: Open laminectomy surgery is the gold standard for lumbar spinal stenosis treatment. However, the recent development of endoscopic techniques is posing questions on when is better to approach a multilevel stenosis with a minimally invasive decompression (MID) with or without an endoscopic approach.
Methods: We systematically searched PubMed, Embase, and Cochrane Central for studies comparing patients with multilevel lumbar stenosis treated with MID with and without an endoscopic approach, versus OLS. Pain was assessed using a visual analog scale (VAS). Mean differences (MDs) and odds ratio (OR) were pooled with a. random-effects model. The p< 0.05 presented a significant statistical result and I² < 40% showed low heterogeneity.
Results: Of 3,695 articles screened, 4 studies and 618 patients were included, of whom 291(47%) were treated with MID and 327(53%) were treated with OLS. MID was associated with a shorter length of stay (MD= -3.26 days, 95% CI [-6.38, -0.13], p=0.04, I²=98%) and intraoperative blood loss (MD=-55.20 mL, 95% CI [-105.73, -4.67], p=0.03, I²=95%). There were no significant differences between the groups in operative time (MD=7.86, 95% CI [-25.28, 41.01], p=0.64, I²=96%), complication rate (OR=0.72, 95% CI [0.04, 14.73], p=0.83, I²=80%), reoperation due to recurrence (OD=0.34, 95% CI [0.06, 1.860], p=0.21, I²=0%) and low back pain (MD=-0.38, 95% CI [-1.83, 1.08], p=0.61, I²=64%).
Conclusion : Our study evaluated OLS versus MID in patients with multilevel lumbar spinal stenosis. We found a reduction in length of stay and intraoperative blood loss with the minimally invasive techniques, which presents a safer treatment of lumbar spinal stenosis.
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