Failure rate of decompression-only procedure for lumbar degenerative spondylolisthesis -Evidence from a PRISMA-compliant systematic review of literature

Introduction: To identify the failure rates of individual methods of decompression-only procedures to aid in the selection of the best possible method to achieve decompression that works the best in the hands of a given surgeon. Methods: An independent systematic review of four scientific databases (PubMed, Scopus, clinicaltrials.gov, Web of Science) was performed to identify relevant articles as per the preferred reporting in systematic reviews and meta-analysis (PRISMA) guidelines. Studies reporting on failure rates of decompressiononly procedure for degenerative lumbar spondylolisthesis were included for analysis. Analysis was performed using the Open Meta Analyst software. Results: The overall failure rate of decompression-only procedure 9.1\% (95\% CI 6.5, 11.7). Further, open decompression had the highest failure rate of 10.9\% (95\% CI 6.5, 11.7), while micro-endoscopic decompression had the least failure rate of 6.7\% (95\% CI 2.9, 10.6). Similarly, the highest failure of 15.4\% (95\% CI 9.4, 21.4) was noted at 2 years while the least failure of 5.8\% (95\% CI -7.0, 18.6) was noted during the first year following surgery. Single level decompression had a failure rate of 10.5\% (95\% CI 7.1, 13.9), while multi-level decompression recorded a failure rate of 6.2\% (95\% CI 2.8, 9.5). Conclusion: High-quality evidence on the decompression-only procedure for degenerative spondylolisthesis is limited. The decompression-only procedure had an overall failure rate of 9.1\% with open decompression approach resulting in the highest failure rates compared to other minimally invasive approaches.