Minimally invasive decompression versus open laminectomy in multilevel lumbar stenosis: A systematic review and meta-analysis

This meta-analysis compares clinical outcomes of minimally invasive decompression (MID) versus open laminectomy surgery (OLS) for multilevel lumbar spinal stenosis. A systematic search was conducted in PubMed, Embase, and the Cochrane Central databases to identify studies comparing MID to OLS in patients with multilevel lumbar spinal stenosis. Primary outcomes were length of hospital stay (LHS), operative time (OT), complication rate (CR), intraoperative blood loss (IBL), reoperation due to recurrence (RDR), and low back pain 1 year after surgery (LBP). Of 3695 articles screened, 4 studies and 618 patients were included, of whom 291 (47%) were treated with MID and 327 (53%) were treated with OLS. There were no significant differences between the groups in OT (Mean Difference (MD)) = 7.68; 95% CI [-20.53, 35.88]; p = 0.59, I2 = 96%), CR (Odds Ratio (OR)) = 0.72; 95% CI [0.04, 14.73]; p = 0.83; I2 = 80%), RDR, LBP and LHS. However, IBL was reduced in MID compared to OLS (MD = -55.20; 95% CI [-105.73, -4.67]; p = 0.03; I2 = 95%), decreasing the need for transfusions and complications. Only the RDR presented a low heterogeneity, while the rest of the outcomes conferred a high heterogeneity. Our study showed important statistical differences between the groups analyzed, likely attributable to inconsistencies in standardized approaches and decompression techniques across studies. Notably, MID demonstrated an advantage over OLS regarding intraoperative blood management.