Degenerative lumbar stenosis with spondylolisthesis is a common indication for spine surgery worldwide. There is Level I evidence that surgery has an advantage over nonsurgical therapies in persistently symptomatic patients.1 However, whether every patient requires a fusion in addition to decompression remains controversial. The idea of fusion in the setting of a spondylolisthesis after laminectomy seems obvious, and previous randomized trials have suggested that it improves outcomes.2,3 However, some have argued that fusion is unnecessary for specific low-grade slips and that it only adds cost, time, and risk. In practice, surgery patterns vary greatly in the United States and on the global scale.
In a recent issue of The New England Journal of Medicine, 2 new randomized controlled trials by Försth et al4 and Ghogawala et al5 present provocative conclusions on the role of fusion in surgery for lumbar stenosis with degenerative spondylolisthesis.
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