• Lukas Schönnagel, Thomas Caffard, Jiaqi Zhu, Soji Tani, Gaston Camino-Willhuber, Dominik A Amini, Henryk Haffer, Maximilian Muellner, Ali E Guven, Erika Chiapparelli, Artine Arzani, Krizia Amoroso, Jennifer Shue, Roland Duculan, Timo Zippelius, Andrew A Sama, Frank P Cammisa, Federico P Girardi, Carol A Mancuso, and Alexander P Hughes.
• Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY.
• Spine. 2024 Feb 15; 49 (4): 261268261-268.

Study DesignA retrospective analysis of prospectively collected data.ObjectiveTo report the decision-making process for decompression alone (DA) and decompression and fusion (DF) at a tertiary orthopedic center and compare the operative outcomes between both groups.BackgroundControversy exists around the optimal operative treatment for DLS, either with DF or DA. Although previous studies tried to establish specific indications, clinical decision-making algorithms are needed.Materials And MethodsPatients undergoing spinal surgery for DLS at L4/5 were retrospectively analyzed. A survey of spine surgeons was performed to identify factors influencing surgical decision-making, and their association with the surgical procedure was tested in the clinical data set. We then developed a clinical score based on the statistical analysis and survey results. The predictive capability of the score was tested in the clinical data set with a receiver operating characteristic (ROC) analysis. To evaluate the clinical outcome, two years follow-up postoperative Oswestry Disability Index (ODI), postoperative low back pain (LBP) (Numeric Analog Scale), and patient satisfaction were compared between the DF and DA groups.ResultsA total of 124 patients were included in the analysis; 66 received DF (53.2%) and 58 DA (46.8%). Both groups showed no significant differences in postoperative ODI, LBP, or satisfaction. The degree of spondylolisthesis, facet joint diastasis and effusion, sagittal disbalance, and severity of LBP were identified as the most important factors for deciding on DA or DF. The area under the curve of the decision-making score was 0.84. At a cutoff of three points indicating DF, the accuracy was 80.6%.ConclusionsThe two-year follow-up data showed that both groups showed similar improvement in ODI after both procedures, validating the respective decision. The developed score shows excellent predictive capabilities for the decision processes of different spine surgeons at a single tertiary center and highlights relevant clinical and radiographic parameters. Further studies are needed to assess the external applicability of these findings.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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