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Whether lumbar spinal stenosis should be treated with decompression alone or decompression plus fusion has important implications for surgical risk, recovery and resource use. In this randomized controlled trial, 247 patients with one- or two-level spinal stenosis, with or without degenerative spondylolisthesis, were assigned to decompression alone or decompression with fusion. At two and five years, disability outcomes and walking performance were not significantly better with fusion. The fusion group had longer hospital stays, more blood loss, longer operative time and higher costs. Additional surgery rates were also similar over longer follow-up. These findings support a selective rather than routine role for fusion in lumbar spinal stenosis. The presence of degenerative spondylolisthesis alone should not automatically be interpreted as an indication for adding instrumentation. For HCPs, the practical lesson is to identify true mechanical instability or another specific reason for fusion rather than adding it reflexively to decompression. Minimising surgical morbidity while preserving function is especially important in older adults with multimorbidity.
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Whether lumbar spinal stenosis should be treated with decompression alone or decompression plus fusion has important implications for surgical risk, recovery and resource use. In this randomized controlled trial, 247 patients with one- or two-level spinal stenosis, with or without degenerative spondylolisthesis, were assigned to decompression alone or decompression with fusion. At two and five years, disability outcomes and walking performance were not significantly better with fusion. The fusion group had longer hospital stays, more blood loss, longer operative time and higher costs. Additional surgery rates were also similar over longer follow-up. These findings support a selective rather than routine role for fusion in lumbar spinal stenosis. The presence of degenerative spondylolisthesis alone should not automatically be interpreted as an indication for adding instrumentation. For HCPs, the practical lesson is to identify true mechanical instability or another specific reason for fusion rather than adding it reflexively to decompression. Minimising surgical morbidity while preserving function is especially important in older adults with multimorbidity.
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