In Spinal Stenosis, Adding Fusion to Decompression Surgery of Little Benefit

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, FASAM

Adding fusion surgery to decompression surgery in patients with spinal stenosis offers little to no benefit and is associated with longer hospital stays and increased costs, according to two New England Journal of Medicine trials.

In the first, nearly 250 adults with lumbar spinal stenosis were randomized to decompression surgery with or without fusion surgery. The primary outcome — patient-reported disability at 2 years — did not differ between the groups. The results were consistent in those with preoperative degenerative spondylolisthesis (55% of the cohort) and those without it.

In the second trial, nearly 70 adults with spinal stenosis and stable degenerative spondylolisthesis were randomized to decompressive laminectomy alone or with fusion. The fusion group showed a clinically meaningful, albeit small, advantage in physical health-related quality of life at 2 years.

Overall, fusion surgery was associated with more bleeding, longer hospital stays, and increased costs.

Editorialists conclude, “The addition of instrumented fusion … for the treatment of the most frequent forms of lumbar spinal stenosis does not create any added value for patients and might be regarded as an overcautious and unnecessary treatment.”