title: To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer?
abstract: BACKGROUND
  Clinical symptoms in lumbar degenerative spondylolisthesis (LDS) vary from predominantly radiating pain to severe mechanical low back pain. We examined whether the outcome of surgery for LDS varied depending on the predominant baseline symptom and the treatment administered [decompression with fusion (D&F) or decompression alone (D)].
  
  
  METHODS
  213 consecutive patients (69 ± 9 years; 155f, 58 m) participated. Inclusion criteria were LDS, maximum three affected levels, no previous surgery at the affected level, and D (N = 56) or D&F (N = 157) as the operative procedure. Pre-op and at 12 months' follow-up (FU), patients completed the multidimensional Core Outcome Measures Index (COMI) including 0-10 leg-pain (LP) and LBP scales. At 12 months' FU, patients rated global outcome which was then dichotomised into "good" and "poor".
  
  
  RESULTS
  Pre-operatively, LBP and COMI scores were significantly worse (p < 0.05) in the D&F group than in the D group. The improvement in COMI at 12 months' FU was significantly greater for D&F than for D (p < 0.001) and was not influenced by the patient's declared "main problem" at baseline (back pain, leg pain, or neurological disturbances) (p > 0.05). There was a higher proportion (p = 0.01) of "good" outcomes at 12 months' FU in D&F (86%) than in D (70%). Multiple regression analysis, controlling for possible confounders, revealed treatment group to be the only significant predictor of outcome (adding fusion = better outcome).
  
  
  CONCLUSIONS
  Our study indicated that LDS patients showed better patient-based outcome with instrumented fusion and decompression than with decompression alone, regardless of baseline symptoms. This may be due to the fact that the underlying slippage as the cause of the stenosis is better addressed with fusion.
authors.affiliation: Spine Center, Schulthess Klinik, Lengghalde 2, 8008 Zürich, Switzerland. frank.kleinstueck@kws.ch
authors.forename: F S
authors.initials: FS
authors.lastname: Kleinstueck
authors.forename: T F
authors.initials: TF
authors.lastname: Fekete
authors.forename: A F
authors.initials: AF
authors.lastname: Mannion
authors.forename: D
authors.initials: D
authors.lastname: Grob
authors.forename: F
authors.initials: F
authors.lastname: Porchet
authors.forename: U
authors.initials: U
authors.lastname: Mutter
authors.forename: D
authors.initials: D
authors.lastname: Jeszenszky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology*; D019299:Decompression, Surgical / Q000009:adverse effects; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013123:Spinal Fusion / Q000009:adverse effects; D013168:Spondylolisthesis / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome