Surgery for spinal stenosis with degenerative spondylolisthesis

Controversy continues about the best surgical option for patients with symptomatic lumbar spinal stenosis and concomitant degenerative spondylolisthesis. At the centre of this controversy is a debate on the efficacy of decompression alone versus decompression with fusion. In this context, durability has been defined as maintenance of clinical benefit without the need for additional intervention.1 The potential benefit of fusion surgery in terms of durability should be weighed against the risks of future reoperations because of adjacent segment disease. Previous randomised controlled trials and observational register studies did little to settle the controversy because the results were inconsistent.2345678910 Three previous randomised controlled trials (two from Scandinavia and one from Japan) reported findings favouring decompression without fusion,234 whereas one randomised controlled trial from the US reported findings favouring decompression with fusion.5 Specifically, the US randomised controlled trial reported significantly higher reoperation rates for patients managed with decompression …