Benefit of lumbar fusion for spinal stenosis found to be small to nonexistent

Both of these studies clearly demonstrated that for most patients, stenosis surgery should be limited to decompression when no overt instability is present. Dr. Ghogawala and his colleagues correctly concluded that the modest difference in SF-36 score in favor of fusion doesn’t justify that procedure’s higher cost and complication rate.

Fusion surgery is no longer best practice and should be restricted to patients who have proven spinal instability; vertebral destruction caused by trauma, tumors, infections, or spinal deformities; or possibly neuroforamen stenosis with compressed exiting nerves due to postsurgical disk collapse.

Dr. Wilco C. Peul is at Leiden (the Netherlands) University Medical Center and at Medical Center Haaglanden, the Hague. Dr. Wouter A. Moojen is at Medical Center Haaglanden. Dr. Peul reported receiving grants from ZonMW, Paradigm Spine, Medtronic, Eurospine Foundation, and CVZ. Dr. Moojen reported having no relevant financial disclosures. Dr. Peul and Dr. Moojen made these remarks in an editorial accompanying the reports on the Swedish Spinal Stenosis Study and the Spinal Laminectomy Versus Instrumented Pedicle Screw trial (N Engl J Med. 2016 April 13. doi: 10.1056/NEJMe1600955).