Study Design: 

This was a systematic review and meta-analysis study.

Objective: 

The purpose of this study is to evaluate the available evidence on the preservation of posterior midline structures in decompression surgery for lumbar spinal stenosis (LSS).

Summary of Background Data: 

The gold-standard treatment for LSS refractory to conservative management is facet-preserving laminectomy. The question remains whether the midline structures should be preserved in decompression surgery for LSS.

Materials and Methods: 

We performed a systematic review of the Medline, PubMed, Embase, and Cochrane databases in search of published reports comparing midline structure preservation (MSP) and conventional laminectomy (CL) for LSS. The population was divided into 2 groups: (1) MSP group (intervention) and (2) CL group (control). The various outcome parameters including blood loss, operation time, hospital stay, back and leg pain, functional scores including Oswestry Disability Index (ODI) score, Japanese Orthopedic Association score, and 36-Item Short Form Survey (SF-36) scores, satisfaction, and instability rates were analyzed. Data were extracted and aggregated for meta-analysis.

Results: 

Of the published reports, 16 met our inclusion criteria with an aggregated 540 in the intervention and 538 in the control groups, respectively. The aggregated data demonstrated patients undergoing MSP had significantly decreased back pain Visual Analog Scale compared with CL, regardless of time after surgery (P=0.007). The MSP group also showed a significantly lower Oswestry Disability Index score and SF-36 Mental Component Summary score (P=0.005 and 0.03, respectively) and longer 6-month walking distance (P<0.00001). The patient satisfaction rate was significantly higher in the MSP group (P=0.02), and the instability rate was significantly lower in the MSP group compared with the CL group (P<0.0001). At 3 days after surgery, MSP significantly decreased the level of creatinine phosphokinase (P<0.00001). Regarding intraoperative blood loss, hospital stay, leg pain Visual Analog Scale score, Japanese Orthopedic Association score, and SF-36 Physical Component Summary score, there were no significant differences between the 2 groups. However, MSP showed significantly higher operation time (P=0.04).

Conclusions: 

We concluded despite heterogenous and limited data, this study suggests that preservation of midline structure leads to less severe back pain, better functional recovery, and satisfaction rate. Meanwhile, it decreases creatinine phosphokinase level and instability rate.

Level of Evidence: 

Level III—therapeutic.

中文翻译：

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腰椎管狭窄减压手术中是否应该保留后中线结构？：系统评价和荟萃分析

学习规划： 

这是一项系统回顾和荟萃分析研究。

客观的： 

本研究的目的是评估腰椎管狭窄症 (LSS) 减压手术中保留后中线结构的现有证据。

背景数据摘要： 

保守治疗难治性 LSS 的金标准治疗是保留小关节的椎板切除术。问题仍然是在 LSS 减压手术中是否应该保留中线结构。

材料和方法： 

我们对 Medline、PubMed、Embase 和 Cochrane 数据库进行了系统回顾，以搜索比较LSS中线结构保留 (MSP) 和传统椎板切除术(CL) 的已发表报告。将人群分为 2 组：(1) MSP 组（干预组）和 (2) CL 组（对照组）。各种结果参数，包括失血量、手术时间、住院时间、背部和腿部疼痛、功能评分，包括 Oswestry 残疾指数 (ODI) 评分、日本骨科协会评分和 36 项简短调查 (SF-36) 评分、满意度，并分析了不稳定率。提取并汇总数据以进行荟萃分析。

结果： 

在已发表的报告中，有 16 份符合我们的纳入标准，干预组总计 540 份，对照组总计 538 份。汇总数据表明，与 CL 相比，接受 MSP 的患者背痛视觉模拟量表显着减轻，无论术后时间如何（P = 0.007）。MSP 组还表现出显着较低的 Oswestry 残疾指数评分和 SF-36 心理成分总结评分（分别为P = 0.005 和 0.03）以及更长的 6 个月步行距离（P <0.00001）。与 CL 组相比，MSP 组患者满意度显着较高（P =0.02），不稳定率显着较低（ P <0.0001）。术后3天，MSP显着降低肌酐磷酸激酶水平（P <0.00001）。关于术中失血量、住院时间、腿部疼痛视觉模拟量表评分、日本骨科协会评分和SF-36身体成分总结评分，两组之间没有显着差异。然而，MSP 的手术时间明显更长（P =0.04）。

结论： 

我们得出的结论是，尽管数据不均匀且有限，但本研究表明，保留中线结构可以减轻背痛的严重程度，改善功能恢复和满意度。同时，降低肌酐磷酸激酶水平和不稳定率。

证据级别： 

III 级——治疗性。