| アブストラクト | BACKGROUND: Lumbar fusion is widely used to treat chronic lumbar degenerative pathology; however, its effectiveness and safety compared with nonoperative management remain controversial. OBJECTIVES: This systematic review and meta-analysis aimed to evaluate and compare the effectiveness and safety of spinal fusion and conservative management in treating lumbar degenerative pathology. METHOD: A systematic review and meta-analysis were conducted following the PRISMA guidelines. The PubMed, Scopus, Cochrane Central, Web of Science, and Embase databases were searched in October 2024. Eligible studies included randomized controlled trials (RCTs) and observational studies reporting pain reduction and functional disability outcomes. The primary outcomes were changes in the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores for back and leg pain. Data were analyzed using a random-effects model in RevMan 5.4.1, with subgroup and sensitivity analyses performed to address heterogeneity. RESULTS: Fourteen studies comprising 13 RCTs and one cohort study, involving 2,399 participants, were included. Spinal fusion showed significant improvements in ODI scores compared to conservative treatment (MD = -6.3; 95% CI [-12.02, -0.57]; p = 0.03), indicating reduced disability. VAS back pain scores also favored spinal fusion (MD = -3.02; 95% CI [-5, 1.04]; p = 0.003), with long-term outcomes showing consistent benefits (MD = -2.26; 95% CI [-3.16, 1.37]; p < 0.00001). However, spinal fusion did not significantly reduce leg pain compared to non-operative options (MD = -2.27; 95% CI [-8.37, 3.83]; p = 0.47). CONCLUSION: Spinal fusion offers statistically significant benefits in reducing disability and back pain compared with conservative treatments for lumbar degenerative pathology. However, it does not confer substantial advantages to leg pain and carries a high surgical risk. These findings emphasize the importance of individualized treatment selection based on patient characteristics and clinical indications. |
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| 投稿者 | Moghib, Khaled; Altalab, Gergis; Jader, Arwa; Ghanm, Thoria I Essa; Hijazy, Mesan; Tarawneh, Dana Y; Hannat, Ramish; Salomon, Izere; Edress, Ahmed Ibrahim; Arafeh, Muhannad Wael Abu; Uwishema, Olivier; Limantoro, Joshua; Luna, Antonio Medina; Bozkurt, Ismail |
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| 組織名 | Faculty of Medicine, Cairo University, Cairo, Egypt.;Medical Research Group of Egypt, Negida Academy, Arlington, MA, USA.;Faculty of Medicine, Merit University, Sohag, Egypt.;Department of Neurosurgery, Kufa University, Kufa, Iraq.;Faculty of Medicine, Mansoura University, Mansoura, Egypt.;Al-Azhar University Gaza, Gaza, Palestine.;School of Medicine, The University of Jordan, Amman, Jordan.;Services Institute of Medical Sciences (SIMS), Lahore, Pakistan.;University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda.;izesajw73@gmail.com.;Department of Neurosurgery, Tanta University, Tanta, Egypt.;Hadassah Medical Center, Jerusalem, Palestine.;Department of Research and Education, Oli Health Magazine Organization, Kigali,;Rwanda.;Faculty of Medicine, Udayana University, Bali, Indonesia.;Universidad de Monterrey, Monterrey, Mexico.;Department of Neurosurgery, Medical Park Ankara Hospital, Ankara, Turkey.;Department of Neurosurgery, School of Medicine, Yuksek Ihtisas University,;Ankara, Turkey. |
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