Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 10: fusion following decompression in patients with stenosis without spondylolisthesis.
Based on the medical evidence derived from the scientific literature on this topic, there does not appear to be evidence to support the hypothesis that fusion (with or without instrumentation) provides any benefit over decompression alone in the treatment of lumbar stenosis in patients in whom there is no evidence of preoperative deformity or instability. A single report provides Class II medical evidence and several papers provide Class III medical evidence suggesting that the addition of fusion to decompression in patients with lumbar stenosis and instability evidenced by movement on preoperative flexion-extension radiographs does improve outcome. There are also reports (Class III medical evidence) indicating that patients with lumbar stenosis, without deformity or instability, treated with wide decompression or facetectomy may suffer iatrogenic lumbar instability. Fusion in these patients may improve outcome. There is conflicting Class III medical evidence regarding the application of instrumentation in addition to PLF in patients treated for lumbar stenosis without deformity or preoperative instability.
Resnick
Daniel K
DK
Department of Neurosurgery, University of Wisconsin Medical School, Madison, Wisconsin 53792, USA. Resnick@neurosurg.wisc.edu
Choudhri
Tanvir F
TF
Dailey
Andrew T
AT
Groff
Michael W
MW
Khoo
Larry
L
Matz
Paul G
PG
Mummaneni
Praveen
P
Watters
William C
WC
Wang
Jeffrey
J
Walters
Beverly C
BC
Hadley
Mark N
MN
D019299:Decompression, Surgical / Q000592:standards*; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D013123:Spinal Fusion / Q000592:standards*; D013130:Spinal Stenosis / Q000601:surgery*; D013168:Spondylolisthesis