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<p>Minimally invasive (MI) tubular decompression seeks to reduce soft‑tissue trauma compared with open laminectomy for lumbar spinal stenosis (LSS). We performed a PRISMA‑compliant systematic review and meta‑analysis of comparative studies (2015–April 2025) identified in PubMed, Embase, and CENTRAL. Adults with symptomatic degenerative LSS undergoing MI tubular decompression or open laminectomy were included. Evaluated outcomes included surgical parameters (e.g., overall complications; dural tears, surgical site infections, reoperation), perioperative and postoperative complications, patient-reported outcome measures (PROMs), and hospital length of stay (LOS). Heterogeneity was measured using I<sup>2</sup>. Random-effects models were primary; PROMs were also analyzed in a common-effect sensitivity analysis. Nine studies involving ten cohorts and a total of 2,860 patients were analyzed from 2,853 records. Random-effects models pooled odds ratios (OR) and mean differences (MD); PROMs were additionally examined with a common-effect model as a sensitivity analysis. MI tubular surgery was associated with fewer overall complications (OR 0.42, 95% CI 0.21–0.86), fewer surgical site infections (OR 0.28, 95% CI 0.11–0.69), lower EBL (MD − 46.65 mL, 95% CI − 80.89 to − 12.41), and shorter LOS (MD − 1.39 days, 95% CI − 1.99 to − 0.79). Reoperation, operative time, dural tears, and PROMs did not differ significantly. Overall, our results suggest that MI tubular-assisted decompression may offer advantages over open surgery for lumbar spinal stenosis. It was associated with lower perioperative morbidity and resource utilization – including lower overall complication rates, fewer surgical-site infections, reduced blood loss, and shorter hospital stays – while achieving similar patient-reported outcomes. Given between-study heterogeneity and the predominance of retrospective cohorts, these results should be interpreted with appropriate caution; nevertheless, when feasible and in appropriately selected patients and settings, tubular-assisted decompression may be considered a preferable option.</p>

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Minimally invasive tubular decompression versus traditional open surgery for lumbar spinal stenosis: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月7日

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  • Ahmet Kartal,
  • Noel F. Manalil,
  • Mousa K. Hamad,
  • Shahier Paracha,
  • Anthony Robayo,
  • Evan Wang,
  • Ibrahim Hussain,
  • Roger Härtl

摘要

Minimally invasive (MI) tubular decompression seeks to reduce soft‑tissue trauma compared with open laminectomy for lumbar spinal stenosis (LSS). We performed a PRISMA‑compliant systematic review and meta‑analysis of comparative studies (2015–April 2025) identified in PubMed, Embase, and CENTRAL. Adults with symptomatic degenerative LSS undergoing MI tubular decompression or open laminectomy were included. Evaluated outcomes included surgical parameters (e.g., overall complications; dural tears, surgical site infections, reoperation), perioperative and postoperative complications, patient-reported outcome measures (PROMs), and hospital length of stay (LOS). Heterogeneity was measured using I2. Random-effects models were primary; PROMs were also analyzed in a common-effect sensitivity analysis. Nine studies involving ten cohorts and a total of 2,860 patients were analyzed from 2,853 records. Random-effects models pooled odds ratios (OR) and mean differences (MD); PROMs were additionally examined with a common-effect model as a sensitivity analysis. MI tubular surgery was associated with fewer overall complications (OR 0.42, 95% CI 0.21–0.86), fewer surgical site infections (OR 0.28, 95% CI 0.11–0.69), lower EBL (MD − 46.65 mL, 95% CI − 80.89 to − 12.41), and shorter LOS (MD − 1.39 days, 95% CI − 1.99 to − 0.79). Reoperation, operative time, dural tears, and PROMs did not differ significantly. Overall, our results suggest that MI tubular-assisted decompression may offer advantages over open surgery for lumbar spinal stenosis. It was associated with lower perioperative morbidity and resource utilization – including lower overall complication rates, fewer surgical-site infections, reduced blood loss, and shorter hospital stays – while achieving similar patient-reported outcomes. Given between-study heterogeneity and the predominance of retrospective cohorts, these results should be interpreted with appropriate caution; nevertheless, when feasible and in appropriately selected patients and settings, tubular-assisted decompression may be considered a preferable option.