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Radiographic follow-up can reveal differences between surgical strategies that are not immediately obvious from symptoms alone. In a randomized cohort from the Swedish Spinal Stenosis Study, two-year MRI findings were compared after decompression alone versus decompression with fusion. New stenosis at the operated or adjacent level occurred more often after fusion, and adjacent-level stenosis was particularly common in the fusion group. Fusion reduced restenosis at the operated level, but this came with a higher rate of new disease elsewhere. The study provides a useful explanation for why greater radiographic stability does not necessarily translate into better long-term clinical outcomes. For HCPs, the practical lesson is to distinguish radiographic endpoints from patient-centred benefit. Adding fusion can alter spinal biomechanics and may create additional radiographic disease, while still not improving disability scores. These data strengthen the case for limiting fusion to patients with a clear biomechanical or deformity indication. They also reinforce the importance of conservative MRI interpretation: radiographic progression should be interpreted in the context of symptoms and function rather than treated as an automatic trigger for another operation.
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Radiographic follow-up can reveal differences between surgical strategies that are not immediately obvious from symptoms alone. In a randomized cohort from the Swedish Spinal Stenosis Study, two-year MRI findings were compared after decompression alone versus decompression with fusion. New stenosis at the operated or adjacent level occurred more often after fusion, and adjacent-level stenosis was particularly common in the fusion group. Fusion reduced restenosis at the operated level, but this came with a higher rate of new disease elsewhere. The study provides a useful explanation for why greater radiographic stability does not necessarily translate into better long-term clinical outcomes. For HCPs, the practical lesson is to distinguish radiographic endpoints from patient-centred benefit. Adding fusion can alter spinal biomechanics and may create additional radiographic disease, while still not improving disability scores. These data strengthen the case for limiting fusion to patients with a clear biomechanical or deformity indication. They also reinforce the importance of conservative MRI interpretation: radiographic progression should be interpreted in the context of symptoms and function rather than treated as an automatic trigger for another operation.
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