Decompression Alone in the Setting of Adult Degenerative Lumbar Scoliosis and Stenosis: A Systematic Review and Meta-Analysis

Abstract

Study Design Systematic review and meta-analysis. OBJECTIVESSurgical decompression alone for patients with neurogenic leg pain in the setting of degenerative lumbar scoliosis (DLS) and stenosis is commonly performed, however, there is no summary of evidence for outcomes. Methods A systematic search of English language medical literature databases was performed for studies describing outcomes of decompression alone in DLS, defined as Cobb angle >10˚, and 2-year minimum follow-up. Three outcomes were examined: 1) Cobb angle progression, 2) reoperation rate, and 3) ODI and overall satisfaction. Data were pooled and weighted averages were calculated to summarize available evidence. Results Across 15 studies included in the final analysis, 586 patients were examined. Average preoperative and postoperative Cobb angles were 17.6˚ (Range: 12.7 - 25˚) and 18.0 (range 14.1 - 25˚), respectively. Average change in Cobb angle was an increase of 1.8˚. Overall rate of reoperation ranged from 3 to 33% with an average of 9.7%. Average ODI before surgery, after surgery, and change in scores were 56.4%, 27.2%, and an improvement of 29% respectively. Average from 8 studies that reported patient satisfaction was 71.2%. Conclusions Current literature on decompression alone in the setting of DLS is sparse and is not high quality, limited to patients with small magnitude of lumbar coronal Cobb angle, and heterogenous in the type of procedure performed. Based on available evidence, select patients with DLS who undergo decompression alone had minimal progression of Cobb angle, relatively low reoperation rate, and favorable patient-reported outcomes.

Limited Improvement With Minimally Invasive Lumbar Decompression Alone for Degenerative Scoliosis With Cobb Angle Over 20°

“…Hasan et al 2 suggested that MI decompression may lead to favorable outcomes in 45 patients with lumbar spinal canal stenosis and a mean Cobb angle of 15.9°. In addition, in 31 patients with a mean Cobb angle of 17.3°, MI decompression did not show a significant difference in MCID achievement compared to a matched MI short fusion 6 . These findings suggest that MI decompression may be an viable treatment option for patients with a Cobb angle ranging from 10° to 20°.…”

“…Early reoperation after decompression is a devastating complication. A systematic review including MI, endoscopic, and open decompression showed that the average reoperation rate was 9.7% 8 . A study comparing full-endoscopic and MI lumbar decompression reported the overall reoperation was 4% within the cohort with a mean Cobb angle of 15.6° 2 .…”

“…Surgical interventions for this combination of conditions can range from decompression alone to deformity corrective surgery 2 . In cases where the symptoms are primarily related to short-segment stenotic lesions and not associated with spinal deformity, short-segment fusion or decompression alone can be viable treatment options 3–6 …”

“…Open decompression surgery has been associated with the risk of disrupting the posterior ligamentous complex (PLC), potentially leading to worsening spinal lumbar deformity, 7 while minimally invasive (MI) decompression has been considered preferable with the benefit of preserving PLC and paraspinal musculature 2,4 . A recent systematic review including MI decompression alone reported no significant progression of Cobb angle and favorable patient-reported outcomes in patients with DS 8 . However, this review highlighted that only four studies focused on MI technique in treating central stenosis with DS, each including a small number of patients.…”

Clinical Results of 10-mm Endoscopic Minimally Invasive Interlaminar Decompression in the Treatment of Lumbar Spinal Stenosis with Degenerative Lumbar Scoliosis and Simple Lumbar Spinal Stenosis

“…Surgical management of DLS includes decompression alone, short-segment fusion, and long-segment fusion, but there is conflicting evidence and wide variation in practice between them. 1,[19][20][21] Studies have shown that patients with DLS have similar imaging findings compared to those with simple LSS, including ligamentum flavum hypertrophy, bulging discs, and facet joint degeneration. 22 Since LSS and DLS mainly affect an elderly population with poor surgical tolerance, less invasive decompression alone is an indispensable surgical option for elderly patients with DLS.…”