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Background <p>Lumbar spinal stenosis is a common cause of pain and disability in older adults, increasingly treated with minimally invasive indirect decompression techniques such as standalone oblique lateral lumbar interbody fusion (OLIF), anterior lumbar interbody fusion (ALIF), and interspinous spacers. Although these three approaches are widely used for single-level disease, no randomized trials directly compare their clinical and radiological outcomes, and existing observational data have not been synthesized within a unified indirect decompression framework.</p> Methods <p>Systematic review following PRISMA 2020 guidelines; searches of PubMed, Scopus, Cochrane CENTRAL, and ProQuest through November 2025. Eight observational studies (N = 465) comparing standalone OLIF, ALIF, or interspinous spacers for single-level LSS were included. Follow-up ranged from 1&#xa0;week to 36&#xa0;months. Primary outcomes: Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) at 12 and 24&#xa0;months. Secondary outcomes: radiological measures and reoperation rates. Risk of bias was assessed using ROBINS-I; evidence certainty via GRADE. This review was prospectively registered with PROSPERO (CRD42023411729).</p> Results <p>OLIF (3 studies, 102 participants) showed substantial 12-month ODI improvement (− 34.2 points; 95% CI: − 38.3 to − 30.1). ALIF (single 64-patient cohort) showed 24-month ODI improvement of − 37.4 points (95% CI: − 40.8 to − 34.0) with greatest lordosis correction (6.2°). Interspinous spacers (253 participants) achieved initial improvement that deteriorated by 24&#xa0;months (ODI: − 16.8 points, below MCID threshold), with higher reoperation rates (7.5%) versus ALIF (3.1%) and OLIF (0% in limited data). All radiological parameters significantly favored fusion techniques (p &lt; 0.001).</p> Conclusions <p>Moderate-quality observational evidence suggests standalone OLIF and ALIF are associated with greater sustained functional improvement than interspinous spacers for single-level LSS beyond 12&#xa0;months. However, the absence of randomized trials and potential selection bias in treatment allocation preclude definitive causal inferences. Interspinous spacers may be considered for carefully selected high-risk patients with explicit counseling regarding higher reoperation rates. Prospective randomized trials with standardized patient selection criteria are needed.</p>

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Indirect decompression strategies for single-level lumbar spinal stenosis: a systematic review and meta-analysis of clinical and radiological outcomes of standalone OLIF, ALIF, and interspinous spacers

  • 期刊论文

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  • 发表日期：

    2026年7月6日

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  • St. Fatimah Zahrah Anwar,
  • Karya Triko Biakto,
  • Muhammad Andry Usman,
  • Jainal Arifin,
  • Moh. Asri Abidin

摘要

Background

Lumbar spinal stenosis is a common cause of pain and disability in older adults, increasingly treated with minimally invasive indirect decompression techniques such as standalone oblique lateral lumbar interbody fusion (OLIF), anterior lumbar interbody fusion (ALIF), and interspinous spacers. Although these three approaches are widely used for single-level disease, no randomized trials directly compare their clinical and radiological outcomes, and existing observational data have not been synthesized within a unified indirect decompression framework.

Methods

Systematic review following PRISMA 2020 guidelines; searches of PubMed, Scopus, Cochrane CENTRAL, and ProQuest through November 2025. Eight observational studies (N = 465) comparing standalone OLIF, ALIF, or interspinous spacers for single-level LSS were included. Follow-up ranged from 1 week to 36 months. Primary outcomes: Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) at 12 and 24 months. Secondary outcomes: radiological measures and reoperation rates. Risk of bias was assessed using ROBINS-I; evidence certainty via GRADE. This review was prospectively registered with PROSPERO (CRD42023411729).

Results

OLIF (3 studies, 102 participants) showed substantial 12-month ODI improvement (− 34.2 points; 95% CI: − 38.3 to − 30.1). ALIF (single 64-patient cohort) showed 24-month ODI improvement of − 37.4 points (95% CI: − 40.8 to − 34.0) with greatest lordosis correction (6.2°). Interspinous spacers (253 participants) achieved initial improvement that deteriorated by 24 months (ODI: − 16.8 points, below MCID threshold), with higher reoperation rates (7.5%) versus ALIF (3.1%) and OLIF (0% in limited data). All radiological parameters significantly favored fusion techniques (p < 0.001).

Conclusions

Moderate-quality observational evidence suggests standalone OLIF and ALIF are associated with greater sustained functional improvement than interspinous spacers for single-level LSS beyond 12 months. However, the absence of randomized trials and potential selection bias in treatment allocation preclude definitive causal inferences. Interspinous spacers may be considered for carefully selected high-risk patients with explicit counseling regarding higher reoperation rates. Prospective randomized trials with standardized patient selection criteria are needed.