Abstract
Introduction
Adjacent segment degeneration (ASDeg) or adjacent segment disease (ASDis) is a matter of concern after lumbar fusion. Whether the motion-preservation procedures could reduce the prevalence of ASDeg or ASDis is still controversial. This meta-analysis aimed to evaluate the efficacy of motion-preservation procedures preventing the ASDeg or ASDis compared with fusion in lumbar spine.
Methods: PubMed, Embase, the Cochrane Library were comprehensively searched and a meta-analysis was performed of all randomized controlled trials (RCTs) and well designed prospective or retrospective comparative cohort studies assessing the lumbar fusion and motion-preservation procedures. We compared the ASDeg/ASDis rate, reoperation rate, operation time, blood loss, length of hospital stay and VAS/ODI improvement of the two procedures.
Results
A total of 15 studies consisting of 1474 patients were included in this study. The meta-analysis indicated that the prevalence of ASDeg, ASDis and reoperation rate on the adjacent level were lower in motion-preservation procedures group than in the fusion group (p = 0.001;p = 0.0004; p < 0.0001). Moreover, shorter length of hospital stay was found in motion-preservation procedures group (p < 0.0001). No difference was found in terms of operation time (p = 0.57), blood loss (p = 0.27), VAS (p = 0.76) and ODI improvement (p = 0.71) between the two groups.
Conclusions
The present evidences indicated that the motion-preservation procedures had an advantage on reducing the prevalence of ASDeg, ASDis and the reoperation rate due to the adjacent segment degeneration compared with the lumbar fusion. And the clinical outcomes of the two procedures are similar.