title: Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9: lumbar fusion for stenosis with spondylolisthesis.
abstract: Patients presenting with stenosis associated with a spondylolisthesis will often describe signs and symptoms consistent with neurogenic claudication, radiculopathy, and/or low-back pain. The primary objective of surgery, when deemed appropriate, is to decompress the neural elements. As a result of the decompression, the inherent instability associated with the spondylolisthesis may progress and lead to further misalignment that results in pain or recurrence of neurological complaints. Under these circumstances, lumbar fusion is considered appropriate to stabilize the spine and prevent delayed deterioration. Since publication of the original guidelines there have been a significant number of studies published that continue to support the utility of lumbar fusion for patients presenting with stenosis and spondylolisthesis. Several recently published trials, including the Spine Patient Outcomes Research Trial, are among the largest prospective randomized investigations of this issue. Despite limitations of study design or execution, these trials have consistently demonstrated superior outcomes when patients undergo surgery, with the majority undergoing some type of lumbar fusion procedure. There is insufficient evidence, however, to recommend a standard approach to achieve a solid arthrodesis. When formulating the most appropriate surgical strategy, it is recommended that an individualized approach be adopted, one that takes into consideration the patient's unique anatomical constraints and desires, as well as surgeon's experience.
authors: Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin;
authors: Daniel K
authors: DK
authors: Resnick
authors: William C
authors: WC
authors: Watters
authors: Alok
authors: A
authors: Sharan
authors: Praveen V
authors: PV
authors: Mummaneni
authors: Andrew T
authors: AT
authors: Dailey
authors: Jeffrey C
authors: JC
authors: Wang
authors: Tanvir F
authors: TF
authors: Choudhri
authors: Jason
authors: J
authors: Eck
authors: Zoher
authors: Z
authors: Ghogawala
authors: Michael W
authors: MW
authors: Groff
authors: Sanjay S
authors: SS
authors: Dhall
authors: Michael G
authors: MG
authors: Kaiser
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D017116:Low Back Pain / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D013123:Spinal Fusion / Q000592:standards*; D013130:Spinal Stenosis / Q000473:pathology / Q000601:surgery*; D013168:Spondylolisthesis / Q000473:pathology / Q000601:surgery*
keywords: ODI = Oswestry Disability Index; PLF = posterolateral lumbar fusion; PLIF = posterior lumbar interbody fusion; SPORT = Spine Patient Outcomes Research Trial; TLIF = transforaminal lumbar interbody fusion; VAS = visual analog scale; fusion; lumbar spine; practice guidelines; spondylolisthesis; stenosis