RCT Finds Problems With Uninstrumented Fusions for Stenosis + Spondylolisthesis

It's a controversial topic, and so each well-done study is informative — this one counts

What’s the Claim?

A randomized clinical trial of older patients with symptomatic spinal stenosis and spondylolisthesis compared decompression plus instrumented versus uninstrumented posterolateral fusion, and found:

  • A much higher likelihood of fusion in the instrumented group (94% vs 31%)
  • A higher risk of reoperation within 2 years among patients in the uninstrumented group (13% vs 2%; most of those in the uninstrumented group were repeat decompression and fusion procedures at the same level for radiculopathy and back pain from recurrent stenosis and pseudarthrosis)
  • No differences in patient-reported outcome scores between the groups, though scores of those who had revision from uninstrumented to instrumented fusion were censored (removed) from the analysis

How’s It Stack Up?