Prospective study of 50 patients with single-level degenerative lumbar spondylolisthesis and spinal stenosis. Compared decompressive laminectomy alone vs. decompression plus bilateral intertransverse process arthrodesis. Followed a mean of 3 years to determine whether adding fusion improves clinical outcomes.
The surgical management of degenerative spondylolisthesis with stenosis was genuinely controversial before this paper. Prior decision-making leaned on retrospective data and age-based heuristics (Wiltse criteria: fuse only if age <60), with many surgeons performing decompression alone to avoid the added morbidity of fusion in elderly patients.
This study changed that calculus. When you see a patient with single-level degenerative spondylolisthesis and stenosis who has failed conservative care, add fusion to your decompression. The outcome advantage is large (96% vs. 44% good/excellent) and does not depend on the patient's age, sex, or disc height.
Do not withhold fusion based on age alone. The mean age in this series was over 63 years, and older patients benefited just as much.
The 36% pseudarthrosis rate is a useful teaching point: even a fibrous or unilateral union appears sufficient to prevent progressive olisthesis and preserve clinical gains. This paper is the historical foundation for the now-standard practice of combined decompression-fusion for this diagnosis, later reinforced by the Spine Patient Outcomes Research Trial (SPORT) data.
Prospective study of 50 patients with single-level degenerative lumbar spondylolisthesis and spinal stenosis. Compared decompressive laminectomy alone vs. decompression plus bilateral intertransverse process arthrodesis. Followed a mean of 3 years to determine whether adding fusion improves clinical outcomes.
The surgical management of degenerative spondylolisthesis with stenosis was genuinely controversial before this paper. Prior decision-making leaned on retrospective data and age-based heuristics (Wiltse criteria: fuse only if age <60), with many surgeons performing decompression alone to avoid the added morbidity of fusion in elderly patients.
This study changed that calculus. When you see a patient with single-level degenerative spondylolisthesis and stenosis who has failed conservative care, add fusion to your decompression. The outcome advantage is large (96% vs. 44% good/excellent) and does not depend on the patient's age, sex, or disc height.
Do not withhold fusion based on age alone. The mean age in this series was over 63 years, and older patients benefited just as much.
The 36% pseudarthrosis rate is a useful teaching point: even a fibrous or unilateral union appears sufficient to prevent progressive olisthesis and preserve clinical gains. This paper is the historical foundation for the now-standard practice of combined decompression-fusion for this diagnosis, later reinforced by the Spine Patient Outcomes Research Trial (SPORT) data.