Indirect Lumbar Decompression Combined With or Without Additional Direct Posterior Decompression: A Systematic...

Area of Science:

• Spine surgery
• Neurosurgery
• Orthopedic surgery

Background:

• Lateral lumbar interbody fusion (LLIF) offers indirect decompression for lumbar stenosis.
• Severe central stenosis may necessitate additional direct posterior decompression.
• Limited direct comparisons exist between isolated indirect decompression and combined approaches.

Purpose of the Study:

• To synthesize literature comparing isolated LLIF indirect decompression with combined indirect and direct posterior decompression.
• To identify significant differences in outcomes and complication rates between these two surgical techniques.

Main Methods:

• Systematic review of MEDLINE, COCHRANE, and EMBASE databases.
• Inclusion of studies reporting adult decompression with oblique or lateral fusion approaches up to September 2020.
• Pooling and statistical analysis of outcome measures and complication rates.

Main Results:

• Fifteen studies involving 557 patients and 1008 levels were analyzed.
• Both techniques improved Oswestry Disability Index (ODI) scores.
• Combined decompression showed a trend towards greater improvement in lumbar lordosis (LL) in cases with worse preoperative alignment, though differences were not statistically significant (P > .05 for LL and P = .053 for ODI).

Conclusions:

• Both indirect decompression (LLIF) and combined indirect/direct decompression improve function and pain in lumbar stenosis.
• Combined decompression may be more effective in restoring lumbar lordosis for patients with significant preoperative spinal malalignment.
• Further research with larger, homogeneous populations is needed for definitive comparisons.