• Nils H Ulrich, Jakob M Burgstaller, Giuseppe Pichierri, Maria M Wertli, Mazda Farshad, François Porchet, Johann Steurer, Ulrike Held, and LSOS Study Group.
• *Department of Orthopedics and Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland †Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Switzerland ‡Division of General Internal Medicine, Bern University Hospital, Bern University, Bern, Switzerland §Spine Division, Balgrist University Hospital, University of Zurich, Switzerland.
• Spine. 2017 Jan 13.

Study DesignRetrospective analysis of a prospective, multicenter cohort study.ObjectiveTo estimate the added effect of surgical fusion as compared to decompression surgery alone in symptomatic lumbar spinal stenosis patients with spondylolisthesis.Summary Of Background DataThe optimal surgical management of lumbar spinal stenosis patients with spondylolisthesis remains controversial.MethodsPatients of the LSOS with confirmed DLSS and spondylolisthesis were enrolled in this study. The outcomes of this study were Spinal Stenosis Measure (SSM) symptoms (score range 1-5, best-worst) and function (1-4) over time, measured at baseline, 6, 12, 24 and 36 months follow-up. In order to quantify the effect of fusion surgery as compared to decompression alone and number of decompressed levels, we used mixed effects models and accounted for the repeated observations in main outcomes (SSM symptoms and SSM function) over time. In addition to individual patients' random effects, we also fitted random slopes for follow-up time points and compared these two approaches with Akaike's Information Criterion (AIC) and the chi-squared test. Confounders were adjusted with fixed effects for age, gender, BMI, diabetes, CIRS musculoskeletal disorders and duration of symptoms.ResultsOne hundred and thirty-one patients undergoing decompression surgery alone (n = 85) or decompression plus fusion surgery (n = 46) were included in this study. In the multiple mixed effects model the adjusted effect of fusion versus decompression alone surgery on SSM symptoms was 0.06 (95% confidence interval, CI: -0.16 to 0.27) and -0.07 (95% CI: -0.25 to 0.10) on SSM function, respectively.ConclusionsAmong the patients with degenerative lumbar spinal stenosis and spondylolisthesis our study confirms that in the two groups, decompression alone and decompression plus fusion, patients distinctively benefited from surgical treatment. When adjusted for confounders, fusion surgery was not associated with a more favorable outcome in both SSM scores as compared to decompression alone surgery.Level Of Evidence3.

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