Noninstrumented Posterolateral Lumbar Fusions Continue to Fade Relative to Instrumented Posterolateral Approaches for Lumbar Degenerative Spondylolisthesis Over the Past Decade

For lumbar degenerative spondylolisthesis, noninstrumented fusion represents a small and declining percentage of PLFs over the past decade, with usage varied by clinical and nonclinical patient characteristics. No differences were found in 90-day aggregated postoperative adverse events and 5-year lumbar revision surgery rates, suggesting that instrumentation can be safely performed and that both approaches had similarly durable results. These findings support considering noninstrumented PLFs in select cases when the safety, utility, or cost-benefit of instrumentation is questioned.