The Slalom Technique as a Motion-Preserving Approach for Multilevel Lumbar Spinal Stenosis: A Systematic Review and Meta-analysis

Abstract Multilevel degenerative spinal stenosis (DSS) is surgically challenging due to longer operative times, greater blood loss, and risk of instability. The Slalom technique, a motion-preserving, minimally invasive approach, has shown promise; however, no randomized controlled trials currently exist to validate its efficacy against standard techniques. This meta-analysis evaluated its operative outcomes in multilevel DSS. Following PRISMA guidelines and PROSPERO registration (CRD420251065160), a comprehensive literature search was performed across PubMed, Embase, and the Cochrane Library through January 2025 to identify relevant studies. Data were extracted from eligible case series, and pooled estimates were synthesized using random-effects models, with heterogeneity assessed via the I 2 statistic. Four case series comprising 327 patients were included. The mean operative time was 56.60 minutes (95% confidence interval CI: 37.48–85.47), hospital stay was 1.94 days (95% CI: 1.53–2.46), and estimated blood loss was 57.74 ml (95% CI: 36.58–91.16). Functional outcomes consistently improved across studies, with Oswestry Disability Index reductions reported up to 24 months. Reported complication rates were low: 4.59 per 100 (95% CI: 2.78–7.47), epidural hematoma (5.5%), and rare instances of cerebrospinal fluid leak or mortality. Based on limited observational data, the Slalom technique appears safe and effective for multilevel DSS. However, the current evidence is restricted to case series, with an absence of randomized comparative data. Additional comparative trials are needed to address existing uncertainties and improve the robustness of the conclusions.