Evaluation of Effectiveness of Treatment Strategies for Degenerative Lumbar Spinal Stenosis: A Systematic Review and Network Meta-Analysis of Clinical Studies.

OBJECTIVE: Lumbar spinal stenosis (LSS) is a common disease in spinal surgery. Many related treatment methods have been reported, but their effectiveness still lacks a systematic comparison. We aimed to evaluate the clinical outcomes related to the efficacy and safety of these treatment strategies via a network meta-analysis.

METHODS: Relevant clinical studies were retrieved from the databases of PubMed, Embase, Web of Science, and Cochrane library updated to July 29, 2020. The data were extracted from the eligible literature and the results were presented as standardized mean differences with 95% confidence intervals (CIs). A network meta-analysis was executed using the netmeta, rjags, and gemtc packages in R software, and Begg and Egger tests were used to assess the publication bias within the included studies.

RESULTS: A total of 21 eligible studies based on 2890 patients with degenerative LSS were included. The newer microdecompression technique (bilateral decompression via unilateral laminotomy [BDUL]) performed better in decreasing the visual analog scale (VAS) score compared with conventional decompressive laminectomy (VAS score back pain, 1.22; 95% CI, 0.28-2.17; VAS score leg pain, 1.39; 95% CI, 0.82-1.96), but its Oswestry Disability Index improvement was slightly inferior to that of posterolateral fusion.

CONCLUSIONS: BDUL could effectively alleviate VAS pain of patients, and had a lower incidence of complications. Although BDUL was slightly inferior to posterolateral fusion in terms of Oswestry Disability Index improvement, the postoperative quality of life of patients treated with BDUL had been significantly improved compared with that before surgery.