腰椎変性すべり症に対する除圧術、除圧術と固定術、および除圧術と動的安定化術のネットワークメタアナリシス

科学分野:

• Spine surgery
• Orthopedics
• Neurosurgery

背景:

• Degenerative spondylolisthesis (DS) is a frequent cause of low back pain and lumbar spinal stenosis.
• Surgical interventions for DS include traditional fusion and newer decompression techniques with or without dynamic stabilization.
• Comparative effectiveness and safety data, including time-effect relationships, for these DS interventions are limited.

研究 の 目的:

• To systematically compare the effectiveness and safety of decompression alone, decompression plus dynamic stabilization, and decompression plus fusion for DS.
• To analyze the time-effect relationship of these interventions over up to 12 years.

主な方法:

• A network meta-analysis of 10 studies (9 RCTs) with 1052 DS patients.
• Interventions: decompression alone, decompression + dynamic stabilization, decompression + fusion.
• Outcomes: VAS-LBP, VAS-LP, ODI, complications, reoperation, operation time, blood loss. Time-effect analysis using TE-max model.

主要な成果:

• No significant global inconsistency or high risk of bias.
• No significant differences in VAS-LBP, VAS-LP, or ODI between the three groups.
• Decompression alone showed significantly shorter operation time and less blood loss compared to other methods.
• Time-effect analysis predicted non-inferiority of decompression alone up to 12 years.

結論:

• Decompression alone is non-inferior to fusion for DS efficacy, with added benefits of shorter operation time and less blood loss.
• Dynamic stabilization added to decompression offers no significant benefits.
• Larger cohorts and longer follow-up are needed for definitive conclusions on DS surgical interventions.