Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9: fusion in patients with stenosis and spondylolisthesis.
The best medical evidence available in the literature confirms the utility of fusion for improving patient outcomes following decompression for stenosis associated with spondylolisthesis. The majority of evidence from other studies comparing outcomes after decompression alone or decompression combined with PLF in patients with stenosis and spondylolisthesis also favors the performance of PLF. The medical evidence regarding the use of pedicle screw fixation in this patient population is rated as Class III and is inconsistent. A consistent benefit associated with the use of pedicle screw fixation has been reported in patients with preoperative instability or kyphosis. Iatrogenic instability following decompression is associated with poor outcomes and may also be treated with PLF involving supplemental instrumentation. The precise definition of instability or kyphosis has varied among researchers and requires further study.
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
D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D013123:Spinal Fusion / Q000592:standards*; D013130:Spinal Stenosis / Q000601:surgery*; D013168:Spondylolisthesis / Q000601:surgery*