title: A rethink of fusion surgery for lumbar spinal stenosis.
abstract: Lumbar spinal stenosis is one of the most common spinal disorders in elderly patients, how to choose decompression alone or decompression plus fusion is still controversial. It was reported that the rate of decompression alone for lumbar stenosis was decreased, whereas the rate of decompression plus fusion was increased recently. Two recent multicenter RCTs papers published in the same issue of N Engl J Med compare the outcomes of decompression alone or decompression plus fusion for lumbar spinal stenosis currently. We combined the results from these two studies using the Stata software, we found that the decompression plus fusion had a significantly more blood loss and longer operative time. And no significant difference was found in the parameters of length of hospital stay, SF-36 Physical Component Summary, Oswestry Disability Index, Visual analogue scales of back pain and leg pain between decompression alone group and decompression plus fusion group. Therefore, based on the current evidence, we advocate a rethink on the decompression plus fusion trend chosen by surgeons, the indications of fusion should be restricted to the lumbar stenosis patients accompanied with spinal instability or deformity.
authors.affiliation: Department of Spinal Surgery, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spine Center, Wenzhou, Zhejiang, China.
authors.forename: Ai-Min
authors.initials: AM
authors.lastname: Wu
authors.affiliation: Department of Mathematics, Hong Kong Baptist University, Hong Kong.
authors.forename: Tie-Jun
authors.initials: TJ
authors.lastname: Tong
authors.affiliation: Department of Spinal Surgery, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spine Center, Wenzhou, Zhejiang, China.
authors.forename: Xiang-Yang
authors.initials: XY
authors.lastname: Wang
mesh_terms: D019299:Decompression, Surgical / Q000379:methods; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013130:Spinal Stenosis / Q000601:surgery*
keywords: Decompression surgery; lumbar fusion; lumbar stenosis; spinal disorder; spondylolisthesis