AO Spine Clinical Practice Recommendations for the Surgical Management of Degenerative Spondylolisthesis: When to Decompress Alone and When to Fuse

Study DesignLiterature review.ObjectiveTo provide a concise review of outcomes of decompression and fusion (D + F) vs decompression (D) alone for degenerative lumbar spondylolisthesis (DLS).Methods6 articles were selected, including 3 randomized clinical trials (RCT), 2 meta-analyses, and 1 radiographic cohort study. Summarized factors affecting the outcomes of D + F vs D alone for DLS and provide expert level clinical recommendations.ResultsGhogawala included DLS patients showing improved SF-36 scores (<i>P</i> = 0.046) and lower re-operation rates (<i>P</i> = 0.05) in D + F patients compared to D alone. Forsth, included patients with stenosis both with and without DLS, and showed no difference in any reported outcome measure or reoperation rate. Austevoll included DLS patients that found that D alone was non-inferior to D + F in the primary outcome measure of ODI reduction at 2-year after surgery. Gadjradi included studies showing higher morbidity in the D + F group, as compared to D alone. Shukla included studies which found there was no difference in the raw patient outcome scores at final follow-up. Blumenthal included DLS patients who received D and reported disc height of >6.5 mm, facet angle >50°, and dynamic motion >1.25 mm were associated with high re-operation rates (45%, 39%, and 54% respectively).ConclusionsThe RCT's and meta-analyses report contradictory conclusions and no blanket statement regarding the efficacy of D + F vs D alone can be made for all patients with DLS. Surgeons should closely review pre-operative imaging for signs of instability in order to better identify appropriate patients for each indication.

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Publication Details

Journal
Global Spine Journal
Published
2025-06-11
DOI
https://doi.org/10.1177/21925682251336755
Citations
1
Primary Topic
Spine and Intervertebral Disc Pathology
Type
article
Field-Weighted Citation Impact
1.47
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article

AO Spine Clinical Practice Recommendations for the Surgical Management of Degenerative Spondylolisthesis: When to Decompress Alone and When to Fuse

Luca Ambrosio, Gianluca Vadalà, Amit Kumar Jain, Ashish D. Diwan et al.
1 citations
Global Spine Journal
Spine and Intervertebral Disc Pathology
1.47
article

AO Spine Clinical Practice Recommendations for the Surgical Management of Degenerative Spondylolisthesis: When to Decompress Alone and When to Fuse

Luca Ambrosio, Gianluca Vadalà, Amit Kumar Jain, Ashish D. Diwan, Hai V Le, Sathish Muthu, Mohamed A. R. Soliman, Waeel O. Hamouda, Hardeep Singh, Jason Pui Yin Cheung, Javad Tavakoli, Juan Pablo Cabrera, Andreas Kyriacou Demetriades, Charles G. Fisher, Zorica Buser, Christopher T. Martin, Philip K. Louie, S. Tim Yoon, Sven Yves Vetter, Xiaolong Chen, Patrick C.H. Hsieh, Veranis Sotirios
article en
1 citations

Abstract

Study DesignLiterature review.ObjectiveTo provide a concise review of outcomes of decompression and fusion (D + F) vs decompression (D) alone for degenerative lumbar spondylolisthesis (DLS).Methods6 articles were selected, including 3 randomized clinical trials (RCT), 2 meta-analyses, and 1 radiographic cohort study. Summarized factors affecting the outcomes of D + F vs D alone for DLS and provide expert level clinical recommendations.ResultsGhogawala included DLS patients showing improved SF-36 scores (<i>P</i> = 0.046) and lower re-operation rates (<i>P</i> = 0.05) in D + F patients compared to D alone. Forsth, included patients with stenosis both with and without DLS, and showed no difference in any reported outcome measure or reoperation rate. Austevoll included DLS patients that found that D alone was non-inferior to D + F in the primary outcome measure of ODI reduction at 2-year after surgery. Gadjradi included studies showing higher morbidity in the D + F group, as compared to D alone. Shukla included studies which found there was no difference in the raw patient outcome scores at final follow-up. Blumenthal included DLS patients who received D and reported disc height of >6.5 mm, facet angle >50°, and dynamic motion >1.25 mm were associated with high re-operation rates (45%, 39%, and 54% respectively).ConclusionsThe RCT's and meta-analyses report contradictory conclusions and no blanket statement regarding the efficacy of D + F vs D alone can be made for all patients with DLS. Surgeons should closely review pre-operative imaging for signs of instability in order to better identify appropriate patients for each indication.

Global Spine JournalVol. 15(7)
University of Technology Sydney (AU), University of Southern California (US), University of Minnesota (US), Virginia Mason Medical Center (US), Johns Hopkins University (US), Cairo University (EG), Emory University (US), Università Campus Bio-Medico (IT), Capital Medical University (CN), Heidelberg University (DE), Sutherland Hospital (AU), Hellenic Air Force (GR), University Hospital Heidelberg (DE), Edinburgh Royal Infirmary (GB), UNSW Sydney (AU), Hospital Regional de Concepción (CL), St George Hospital (AU), Center for Neurosciences (US), Security Forces Hospital (SA), Neurological Surgery (US), Vancouver Spine Surgery Institute (CA), Government Medical College (IN), Cairo University hospitals (EG), New York University (US), University at Buffalo, State University of New York (US), UConn Health (US), University of California, Davis (US), University of Hong Kong (HK)
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Openalex Percentile: Top 19%
Spine and Intervertebral Disc Pathology
1.47
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