Can Indirect Decompression Reduce Adjacent Segment Degeneration and the Associated Reoperation Rate After Lumbar Interbody Fusion? A Systemic Review and Meta-analysis

Abstract

We sought to assess and compare the rate of adjacent segment degeneration (ASDeg), adjacent segment disease, and related reoperations between patients who underwent lumbar interbody fusion surgery using indirect or direct decompression. On the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review and meta-analysis was performed to identify and analyze studies that compared the rate of ASDeg, adjacent segment disease, and related reoperations between indirect and direct decompression techniques. Indirect decompression included anterior lumbar interbody fusion, lateral lumbar interbody fusion, and oblique lateral interbody fusion, whereas direct decompression included posterior or transforaminal lumbar interbody fusion. Seven studies including a total of 576 patients (indirect: 314; direct: 262) were identified. The pooled rates of ASDeg were 19.4% (45/232) and 34.9% (66/189) for indirect and direct decompression, respectively. A fixed-effects model showed 0.34 times lower odds of developing ASDeg in the indirect decompression group (odds ratio= 0.34, 95% confidence interval [CI]= 0.20, 0.57). The pooled incidence of reoperation was 2.5% (8/314) and 6.1% (16/262) for indirect and direct decompression, respectively. A fixed-effects model showed 0.40 times lower odds of reoperation fromASDeg in the indirect decompression group (odds ratio= 0.40, 95% CI= 0.18, 0.89). The pooled mean difference for the segmental lordosis angle was 1.80 degrees (95% CI=0.74, 2.86) and 7.11 degrees (95% CI= 4.47, 9.74) for total lumbar lordosis angle, favoring indirect decompression. Indirect decompression showed lower odds of developing ASDeg and undergoing reoperation for ASDeg after lumbar interbody fusion surgery in this meta-analysis. However, the limited number and quality of the included studies should be considered when interpreting the results.