Evidence-Based Recommendations for Spine Surgery
While the efficacy of surgical treatment has been well established, the comparative effectiveness of adding instrumented lumbar spinal fusion to decompressive laminectomy in lumbar spondylolisthesis and spinal stenosis is controversial. Nonrandomized, prospective comparative studies have found evidence of laminectomy with fusion being superior but there is no Class I evidence. In partial contrast, other prospective studies with at least 5 years of postsurgery follow-up demonstrate excellent outcomes with only lumbar decompression. The lack of high quality evidence hinders development of clinical practice guidelines. The SLIP trial (spinal laminectomy vs. instrumented pedicle screw) reported by Ghogawala et al1 reports the results at 2 years of surgical patients randomized to either decompression or decompression and fusion for lumbar degenerative spondylolisthesis.