Abstract
BACKGROUND: Degenerative spondylolisthesis (DS) is a common cause of low back pain and lumbar spinal stenosis, necessitating various surgical interventions. Traditional management includes fusion surgery, but recently decompression with or without dynamic stabilization has been explored. However, the relative efficacy and safety of these interventions, including their time-effect relationships, have not been comprehensively evaluated. OBJECTIVE: To systematically assess and compare the effectiveness and safety of decompression alone, decompression plus dynamic stabilization, and decompression plus fusion in patients with low back pain due to DS, and to analyze the time-effect relationship among these interventions over a follow-up period of up to 12 years. METHODS: A network meta-analysis was conducted involving 10 studies, including 9 randomized controlled trials, with a total of 1052 participants diagnosed with DS. The interventions compared were decompression alone, decompression plus dynamic stabilization, and decompression plus fusion. Primary outcomes included visual analog scale for low back pain (VAS-LBP), visual analog scale for leg pain (VAS-LP), and Oswestry disability Index (ODI). Secondary outcomes were complications, reoperation rate, operation time, and blood loss. We assessed global inconsistency, risk of bias, and conducted a time-effect analysis using the TE-max model. RESULTS: The analysis did not reveal significant global inconsistency or a high risk of bias among the included studies. There were no significant differences between the three interventions regarding changes in VAS-LBP, VAS-LP, and ODI. Decompression alone was associated with significantly shorter operation time (MD = 89.5, 95% CI - 123.91 to - 55.12) and less blood loss (MD = 151.5, 95% CI 37.31 to 265.70) compared to both decompression with fusion and decompression with dynamic stabilization. The time-effect analysis predicted non-inferiority of decompression alone compared to other methods over a follow-up period of up to 12 years. CONCLUSIONS: Decompression alone demonstrates non-inferiority in terms of efficacy for treating low back pain due to DS compared to fusion, with additional benefits in operation time and blood loss. The addition of dynamic stabilization to decompression does not yield significant benefits. Further research with larger cohorts and extended follow-up is necessary for definitive conclusions.