Clinical Outcomes of Decompression Versus Decompression With Instrumented Fusion for Lumbar Spinal Stenosis Secondary to Degenerative Spondylolisthesis: A Systematic Review and Meta-Analysis

Abstract

Summary Objective: To compare decompression alone with decompression with fusion in patients with degenerative lumbar spondylolisthesis. Methods: PubMed, Google Scholar, Ovid, and Web of Science databases were searched up to March 2025 for randomized controlled trials (RCTs). The primary outcomes were the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores. The secondary outcomes included operative time, length of hospital stay, intraoperative blood loss, reoperation, complications, and cost. Pooled analysis was performed using a random-effects model in Review Manager following Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. The quality of included randomized trials was evaluated using the Cochrane risk-of-bias tool. Results: Of the 4,507 studies, 5 RCTs (n = 898) were included. Both interventions improved ODI and VAS scores, with no significant differences for ODI (mean difference [MD], –3.21; 95% confidence interval [CI], –6.59 to 0.17, p = 0.06) or VAS leg pain (MD, –1.67; 95% CI, –8.85 to 5.51, p = 0.65). Decompression showed greater improvement in VAS back pain (MD, –7.48; 95% CI, –14.23 to –0.73, p = 0.03). Perioperative outcomes favored decompression, with a shorter operative time (95 min), shorter hospital stay (1.7 days), and lower blood loss (322 mL). Complications were more frequent with fusion, whereas reoperation rates did not differ. One study reported lower decompression costs (5,400 versus 12,200 USD). Conclusions: Both interventions significantly improved pain and disability. Decompression alone was associated with a lower perioperative morbidity and some evidence of greater back pain relief, supporting its role as a reasonable initial surgical option, with fusion reserved for patients requiring stabilization.