Comparison of the early clinical efficacy of percutaneous endoscopic transforaminal lumbar decompression and single-level lumbar intervertebral fusion in the treatment of lumbar degenerative spondylolisthesis with lumbar spinal stenosis

The clinical efficacy of decompression with versus without fusion for lumbar degenerative spondylolisthesis (LDS) with lumbar spinal stenosis (LSS) remains controversial. This study compared the early clinical outcomes of percutaneous transforaminal endoscopic decompression (PTED) versus single-level lumbar interbody fusion for treating LDS with LSS. This retrospective cohort study included 54 patients with low-grade (Meyerding grade I) LDS and LSS treated between August 2018 and December 2020. Twenty-six patients underwent PTED and 28 underwent fusion surgery, with a minimum 2-year follow-up. Clinical outcomes were assessed using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and Modified Macnab criteria. Perioperative parameters and radiological slippage rates were also compared. Both groups achieved significant improvements in VAS and ODI scores postoperatively ( p < 0.05). The PTED group demonstrated significantly better ODI scores at 3 and 6 months ( p < 0.05), but differences were no longer significant at 12 and 24 months ( p > 0.05). Modified Macnab excellent/good rates were comparable (PTED: 92.31% vs. fusion: 92.86%). PTED was associated with significantly shorter operative time, less blood loss, shorter hospital stays, and earlier ambulation (all p < 0.05). Radiologically, fusion achieved superior slip reduction ( p < 0.001), but this did not correlate with better functional outcomes. One patient in each group required reoperation; none was attributed to slip progression. PTED and fusion achieved comparable 2-year clinical outcomes in selected patients with stable, low-grade LDS and LSS. PTED offered advantages in perioperative morbidity and early recovery, while fusion provided better radiographic correction without clinical superiority. Decompression alone appears a safe and effective alternative to fusion in carefully selected patients with predominant stenotic symptoms and no dynamic instability. Larger prospective studies are warranted to confirm these findings.