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For adults with lumbar degenerative spondylolisthesis and symptomatic back or leg pain lasting at least three months, the addition of fusion to decompression is not associated with differential effects at 12 months, according to a study published online in the Annals of Internal Medicine.

Harrison J. Hansford, Ph.D., from the University of New South Wales Sydney, and colleagues examined the comparative effectiveness of decompression with fusion versus decompression alone among adults aged 18 to 80 years with lumbar degenerative spondylolisthesis and symptomatic back or leg pain lasting at least three months. The Oswestry Disability Index (ODI) score and reoperation at 12 months were the primary outcomes.

Data were included for 2,252 patients: 1,446 with decompression alone and 806 with decompression with fusion. The researchers found that the ODI scores at 12 months were 22.3 and 20.0 for decompression alone and decompression with fusion, respectively (mean difference, 2.2; 95% confidence interval, −1.6 to 6.1). Men with a body mass index of 30 kg/m² or higher had a worse ODI score for decompression with fusion in exploratory analyses. No difference was seen between the groups in reoperation risk at 12 months.

"This study calls into question the highly prevalent management of pain from lumbar degenerative spondylolisthesis with fusion," the authors write.

Harrison J. , Decompression With or Without Fusion Across Subgroups With Degenerative Lumbar Spondylolisthesis, Annals of Internal Medicine (2026).

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