Fusion for lumbar spinal stenosis?

Patients with lumbar spinal stenosis (narrowing of the spinal canal causing compression of the nerve roots) present with a combination of low back pain and leg pain, numbness, and heaviness. The condition is best managed surgically,1 but which operation should be used?

Traditionally, spinal stenosis is treated with lumbar decompression (laminectomy), but in the US increasing numbers of patients are treated with fusion in addition to decompression.2 The evidence to support this change is weak, with prospective non-randomised trials showing some benefit from the addition of fusion.3

Two recent randomised controlled trials from Sweden4 and the United States 5 give some long awaited guidance on surgical management. Both studies were of patients aged 50-80 years with “pure” lumbar stenosis; patients with scoliosis, spondylolysis (pars fracture), lumbar disc herniation, and non-degenerative lumbar stenosis were excluded.Försth and colleagues divided their patients into those with a …