Surgery for Degenerative Lumbar Spondylolisthesis: Is Fusion Necessary?

Patients with lumbar spinal stenosis and degenerative spondylolisthesis often undergo surgery when their back and leg pain become intolerable. In addition to surgical decompression, many surgeons perform instrumented fusion (i.e., bone grafting plus insertion of rods, screws, or plates), but the benefit of adding fusion to decompression is controversial. In this trial from Norway, 267 patients with symptomatic lumbar stenosis and single-level spondylolisthesis (mean slippage, 7 mm) were randomized to decompression alone or decompression plus instrumented fusion.

At 2 years, the proportion of patients whose scores on the widely used Oswestry Disability Index had decreased by at least 30% — the primary outcome — was about 72% in both groups. O…