Abstract
Background
Degenerative spondylolisthesis (DS) is a common cause of low back pain and lumbar spinal stenosis, necessitating various surgical interventions. Traditional management includes fusion surgery, but recently decompression with or without dynamic stabilization has been explored. However, the relative efficacy and safety of these interventions, including their time-effect relationships, have not been comprehensively evaluated.
Objective
To systematically assess and compare the effectiveness and safety of decompression alone, decompression plus dynamic stabilization, and decompression plus fusion in patients with low back pain due to DS, and to analyze the time-effect relationship among these interventions over a follow-up period of up to 12 years.
Methods
A network meta-analysis was conducted involving 10 studies, including 9 randomized controlled trials, with a total of 1052 participants diagnosed with DS. The interventions compared were decompression alone, decompression plus dynamic stabilization, and decompression plus fusion. Primary outcomes included visual analog scale for low back pain (VAS-LBP), visual analog scale for leg pain (VAS-LP), and Oswestry disability Index (ODI). Secondary outcomes were complications, reoperation rate, operation time, and blood loss. We assessed global inconsistency, risk of bias, and conducted a time-effect analysis using the TE-max model.
Results
The analysis did not reveal significant global inconsistency or a high risk of bias among the included studies. There were no significant differences between the three interventions regarding changes in VAS-LBP, VAS-LP, and ODI. Decompression alone was associated with significantly shorter operation time (MD = 89.5, 95% CI − 123.91 to − 55.12) and less blood loss (MD = 151.5, 95% CI 37.31 to 265.70) compared to both decompression with fusion and decompression with dynamic stabilization. The time-effect analysis predicted non-inferiority of decompression alone compared to other methods over a follow-up period of up to 12 years.
Conclusions
Decompression alone demonstrates non-inferiority in terms of efficacy for treating low back pain due to DS compared to fusion, with additional benefits in operation time and blood loss. The addition of dynamic stabilization to decompression does not yield significant benefits. Further research with larger cohorts and extended follow-up is necessary for definitive conclusions.
Supplementary Information
The online version contains supplementary material available at 10.1186/s13018-025-06550-0.
Keywords: Degenerative spondylolisthesis, Decompression, Dynamic stabilization, Fusion, Low back pain, Time-effect analysis, Meta-analysis
Introduction
Degenerative spondylolisthesis (DS) of the lumbar spine is a condition characterized by the slippage of one vertebra relative to the lower adjacent segment. This degenerative process typically affects middle-aged to elderly populations [1]. With the aging of society, DS has become increasingly prevalent, affecting 19.1% to 43% of individuals [2]. Symptoms include low back pain, leg pain, and intermittent neurogenic claudication, all of which can significantly impair quality of life [3]. As a result, DS has become one of the most common indications for lumbar spinal surgery, where it can be effectively treated [4].
Currently, posterior decompression combined with fusion is often advocated for treating DS, especially in cases with spinal stenosis and significant instability. This approach aims to alleviate neurogenic claudication, stabilize the motion segment, and address low back pain. Consequently, spinal fusion has emerged as the "gold standard" treatment for spondylolisthesis [3]. However, some authors argue that decompression alone may be comparable to fusion in treating low-grade spondylolisthesis [5]. The North American Spine Society's clinical guidelines even recommend decompression for low-grade (< 20%) DS, considering fusion an excessive procedure for joint immobilization [6]. Over the past decades, the choice between these procedures has remained controversial, and the introduction of decompression plus dynamic stabilization has further complicated the decision-making process [7].
Proponents of dynamic stabilization highlight well-documented adverse effects associated with fusion techniques. They assert that altering the biomechanical environment may exacerbate symptomatic adjacent segment disease, instrumentation problems, and the potential for symptomatic pseudarthrosis [8]. In contrast to fusion, they advocate for less-invasive, motion-preserving alternatives that combine direct decompression with motion segment stabilization. Although decompression plus fusion is the most common of these three procedures, the relative strengths and weaknesses of each approach cannot be overlooked.
Recently, some authors have clarified their stance on this issue through well-designed protocols or long-term surgical results from prospective randomized controlled trials (RCTs). These studies have reached varying conclusions, underscoring the complexity of selecting the most appropriate surgical method for DS [9]. Furthermore, most early studies on DS were limited to 1 to 2 years outcomes. With the emergence of new publications featuring longer follow-up periods, the time-effect relationship among these interventions may become clearer. Therefore, a network meta-analysis was performed to evaluate the effects of decompression, decompression plus fusion, and decompression plus dynamic stabilization for low-grade DS. Network meta-analysis combines both direct evidence from RCTs and indirect evidence obtained through common comparators [10]. Therefore, with the guidelines of network meta-analysis, this study was to identify the effects of three types of surgical methods for low-grade DS.
Methods
This study was conducted in accordance with the network meta-analysis extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-NMA) guidelines, the recommendations of the Cochrane Collaboration, and the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) criteria. The protocol was approved by the ethics committee of our hospital and has been registered in PROSPERO (CRD42021225727).
Search strategies
The databases used for searching include PubMed, Cochrane Library (CENTRAL), EMBASE, Ovid, and Web of Science from inception to October 31, 2022. The keywords for search terms relating to decompression, fusion, dynamic stabilization, and spondylolisthesis, with the filters of “randomized controlled trials”. The search strategy is shown in Supplementary Appendix 1. Teams of paired reviewers independently used NoteExpress (version 3.7) to firstly screen titles and abstracts, and then full-text manuscripts. Discrepancies were resolved by discussion or by third party adjudication.
Eligible RCTs enrolled patients who were 18 to 70 years of age with radiologically proven low-grade lumbar DS, from L2/3 to L5/S1level, with neurological symptom lasted for more than 3 months (when the conservative treatment is considered unsatisfied or failed). The interventions referred to decompression alone, decompression plus fusion, decompression plus stabilization or similar approaches and the comparators were the three types of surgery themselves. The outcomes contained clinical function or surgery-related information.
We excluded trials for these reasons: (1) RCTs mixed with observational study and inseparable; (2) abnormal instability (> 3 mm) on dynamic radiograph and progressive spondylolisthesis; (3) referred to spondylolisthesis combined scoliosis, tumors or fractures, or other spondylolisthesis such as isthmic and traumatic types; (4) patients with a previous history of lumbar spinal surgery, multilevel stenosis, or foraminal stenosis; (5) follow up time less than 8 weeks since the surgical effect may fluctuates within the time.
Data extraction and quality assessment
Two reviewers independently performed data extraction using a standardized form. Details regarding study identifiers, design, setting, participant baseline characteristics, interventions, follow-up time, and outcomes were extracted into an electronic database. The change of visual analogue scale on low back pain and leg pain (VAS-LBP and VAS-LP), as well as the change of Oswestry disability index (ODI), were regarded as primary outcomes. The change of ZCQ and SF-36, the rate of complications, reoperations, and olisthesis progression as well as operation time and blood loss were seen as secondary outcomes. The change of continuous variables expressed by mean and standard deviation (SD) and and the change of event number for dichotomous were separately used to compare the effects among the three interventions.
The same team independently assessed the risk of bias of individual studies according to the Cochrane Handbook for Systematic Reviews of Interventions recommended RCT quality evaluation standards. Each item was evaluated as low risk, high risk, or uncertain. Disagreement was resolved by joint review to reach consensus. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to rate the quality of evidence as high, moderate, low, or very low by taking into account the within-study limitations, imprecision, heterogeneity, indirectness, and publication bias for each outcome. GRADE was performed using CINeMA (Confidence In Network Meta-analysis, https://cinema.ispm.unibe.ch/). We reported this study according to the Preferred Reporting Items for Systematic Reviews and Network Meta-Analyses (PRISMA-NMA) checklist.
Data synthesis and statistical analysis
A total of 16 primary and secondary outcomes were of interest in this study. Of these, outcomes involving all 3 types of interventions were subjected to network meta-analysis, and those involving only any 2 of these interventions were subjected to traditional pairwise meta-analysis.
Network meta-analysis
We performed a frequentist random-effects network meta-analysis. Continuous variables were reported as weighted mean difference (WMD) and 95% confidence interval (95% CI) by Inverse Variance method, while dichotomous variables were shown as odds ratios (ORs) and 95% CI using the Mantel–Haenszel method. We obtained the result of any pairwise comparison in the network evidence body through direct or indirect comparison, and present the comparison results in league tables. Based on the compare results, the efficacy ranking or risk ranking of the three interventions were performed, and the risk ranking was plotted using the cumulative probability ranking curve, with a larger surface under the cumulative ranking curve (SUCRA) indicating that the intervention was more efficacious or riskier in that outcome. P < 0.05 was considered a difference of statistically significant.
We tested for consistency, heterogeneity, and transitivity in network meta-analysis. In network meta-analysis, we first fit the inconsistency model and calculate the chi-squared value and P-value to measure the global inconsistency, if the P value > 0.05, we consider that there is no global inconsistency and the consistency model can be used, and vice versa, we choose the inconsistency model. A node-splitting model and a loop-specific plots were used to assess the local inconsistency between direct and indirect treatment effects and loop inconsistency. A predictive interval plot was used to evaluate the heterogeneity in the network meta-analysis, significant heterogeneity between studies was considered to exist if the prediction interval crossed the null line. A series of box plots were drawn to compare whether there were significant differences in baseline information between different comparison pairs, so as to evaluate the transitivity assumption of this network body of evidence.
In addition, a model-based network meta-analysis (MBNMA) reflecting time-effect relationship among three interventions was then performed, mainly for the primary outcomes. In the process, the fitting linear models, logarithmic models or TE-max models were regarded as selecting models. Then the predicted value and the predicted time-effect curves on all-time outcomes among interventions were depicted by optimal models.
Traditional pairwise meta-analysis
For the outcomes involving only 2 interventions, we combined the available data directly by traditional head-to-head meta-analysis, with relative effects reported as weighted mean difference (WMD) and 95% confidence interval (95% CI) for continuous outcomes and odds ratios (ORs) and 95% CI for dichotomous outcomes. We test for heterogeneity by calculating I2, heterogeneity was considered small when I2 < 25%, moderately acceptable when 25% ≤ I2 ≤ 50%, and large when I2 > 50%. The results were finally plotted as forest plots.
All analyses (pairwise meta-analysis, network meta-analysis, and estimation of inconsistency, heterogeneity and transitivity) and graphing were conducted by using STATA Version.17.0. Publication bias was evaluated according to whether the funnel plot was symmetrical.
Results
Study characteristics
After searching the databases, there were 859 potentially eligible studies, of which 693 remained after the removal of duplicates. After the full text of these records was screened, 10 studies with 9 RCTs (n = 1052) were eventually included for network analysis (Fig. 1), where two studies referring to the same RCTs with difference follow-up time were both included [3, 8, 9, 11–18]. The details of study characteristics were reported in Supplementary Appendix 2.
Fig. 1.
The flowchat of selection for eligible studies for netword analysis
Risk of bias
The characteristics of intervention made blinding for participants were impossible, so no “blinding patients” in all studies was as “low risk”. There was a low risk of bias in random sequence generation in all studies and six RCTs (55.6%) described the method of allocation concealment with low risk. Details on the risks of bias for included studies was reported in Supplementary Appendix 3. Fewer than 10 studies were included for all primary and secondary outcomes, so it was not appropriate for funnel plots to test for publication bias.
Network meta-analysis
Of all the outcomes of interest in this study, a total of 11 outcomes were suitable for network meta-analysis, including: VAS LBP, VAS-Leg, blood loss, OP time, hospitalization, complication, reoperation, LS progressed, ODI, ZCQ, and SF-36 PCS.
Inconsistency and heterogeneity test
The overall inconsistency of all 11 outcomes showed P > 0.05, which represents that global inconsistency was not significant. Local and loop inconsistency, and heterogeneity test results were described separately for each outcome below.
The change of VAS-LBP and VAS-LP
Analysis on the change of VAS-LBP and VAS-LP
Six RCTs reporting data from 740 participants compared the change of both VAS-LBP and VAS-LP. There were 4 studies of decompression, 5 of decompression plus fusion and 2 of decompression plus dynamic stabilization for primary outcomes. The node-splitting model and loop-specific plots showed no local inconsistency for both VAS-LBP and VAS-LP (P > 0.05). The predictive interval plot also showed no heterogeneity for both outcomes. No statistical differences were found in VAS-LBP among the interventions, so was the change of VAS-LP. The network maps and league tables were shown in Fig. 2.
Fig. 2.
The network maps and league tables on the change of VAS-LBP and VAS-LP with Decompression alone, D+F and D+Dy
The distribution of the probabilities of change of VAS-LBP and VAS-LP of each intervention ranked is shown in Fig. 3. For the change of VAS-LBP, the probability of the interventions was decompression plus fusion (47.9%), dynamic stabilization (38%) and decompression alone (14.2%), the similar trend was shown for the change of VAS-LP.
Fig. 3.
The distribution of the probabilities of change of VAS-LBP and VAS-LP of each intervention ranked
The change of ODI
Four RCTs reporting data from 520 participants compared the change of ODI. There were respectively 3, 4, and 1 studies of decompression, decompression plus fusion, and decompression plus dynamic stabilization. The node-splitting model showed no local inconsistency and the predictive interval plot also showed no heterogeneity (P > 0.05). No statistical differences were found in ODI among three interventions (Fig. 2). In addition, the probability of the interventions was decompression alone (62.3%), decompression plus fusion (28.6%) and dynamic stabilization (9.1%) (Fig. 3).
Analysis on secondary outcomes
All outcomes performed network analysis showed no local inconsistency by node-splitting model except SF-36 PCS between decompression and decompression plus fusion (P = 0.009). Meanwhile, all outcomes showed no heterogeneity.
Three RCTs reporting the change of SF-36 (Physical Component Summary) showed a mean difference (MD) of 9.95 (95% CI 3.39 to 16.52) between the decompression-alone group and the dynamic stabilization group, and an MD of -6.76 (95% CI 1.30 to 12.21) between the decompression-alone group and the fusion group. No significant inter-group differences were observed for ZCQ. An overall of 7 RCTs referring to complications was analyzed, which showed statistical difference between dynamic group and fusion group (OR = 2.72) but no differences between the others. Similarly, the rate of reoperation with 7 RCTs (n = 770) showed statistical difference between dynamic and fusion group (OR = 2.74) but not for the others. The rate of olisthesis progression with 3 RCTs showed no statistical differences.
There were 6 RCTs recording operation times with 744 cases. The time in the decompression-alone group was less than in the fusion group (MD = 89.5, 95% CI − 123.91 to − 55.12), but no significant differences were found in other comparisons. Surgery bleeding showed statistical differences between the decompression-alone and fusion group (MD = 151.5, 95% CI 37.31 to 265.70), between the decompression-alone and dynamic group (MD = 208.6, 95% CI − 315.55 to − 101.71), and between the dynamic and fusion group (MD = 360.1, 95% CI − 432.72 to − 287.54). Hospitalization time showed statistical differences between the dynamic and fusion group (MD = 1.70, 95% CI − 1.75 to − 1.65). The probability of the interventions for each secondary outcome is shown in Supplementary Appendix 4.
Pairwise meta-analysis on the secondary outcomes
Other outcomes referring to decompression-alone and fusion instead of dynamic stabilization were performed by pairwise meta-analysis. The proportions of satisfaction reported statistical difference between the two groups (OR = 1.75), but not for EQ-5D. In addition, the number of cases with LBP and LP reduction after surgery showed no statistical differences (OR = 0.75 and OR = 0.98, respectively), while the ratio of adjacent segment degeneration (2 RCTs, n = 201) reported differences between the two groups (OR = 2.35) (Supplementary Appendix 4).
Time-effect relationship by MBNMA
The primary outcomes of VAS-LBP and VAS-LP were performed by MBNMA. The were five studies referring to follow-up time for both outcomes, ranging from 12 to 144 months. TE-max model was proven as the optimal model. For VAS-LBP, it showed no statistical differences for fusion group (0.33, − 2.35 to 2.88) and dynamic group (0.96, − 5.91 to 7.24) compared to decompression alone group, on the whole. The time-effect curves also showed no statistical differences between fusion and decompression group and between dynamic and decompression group (Fig. 4). The similar tendency to that of VAS-LP (Supplementary Appendix 7).
Fig. 4.
The time-effect curves between D+F and decompression group and between D+Dy and decompression group
Discussion
Among patients with lumbar canal stenosis and low back pain due to DS, fusion has been considered a “gold standard” [19]. However, nonfusion techniques like decompression alone or dynamic stabilization have challenged this standard. This study is the first to present long-term results of a network meta-analysis comparing decompression alone, decompression plus dynamics, and decompression plus fusion, including time-effect prediction.
The results showed no statistical difference in improvements of VAS-LBP and VAS-LP among the three groups. Fusion surgery's superiority lies in segmental translation disappearance and local disc height preservation. However, several cohort studies have not shown substantial benefits from fusion over decompression alone for spondylolisthesis [20]. The natural course of untreated degenerative spondylolisthesis does not correlate with progression of slip or clinical symptoms, and the removal of non-bearing structure by partial laminectomy does not aggravate segmental instability [21].
An important consideration in interpreting these results is the influence of surgical technique and patient selection. As rightly noted, adequate neural decompression for lumbar spinal stenosis, even in decompression-alone procedures, typically involves a partial medial facetectomy to address the lateral recess. The integrity of the facet joints is indeed crucial for stability. Our findings suggest that for carefully selected patients with low-grade spondylolisthesis and no significant dynamic instability—a key inclusion criterion in the analyzed RCTs—the residual stability after a conservative facetectomy is sufficient to achieve outcomes comparable to more extensive procedures over the long term. Conversely, the potential benefits of fusion in correcting segmental deformity or global spinal imbalance are well-recognized. However, our analysis specifically focused on patients with low-grade slips without such significant deformities. Therefore, the non-inferiority of decompression alone may not extend to patients with higher-grade spondylolisthesis, coronal or sagittal malalignment, where fusion would be indicated to restore spinal balance.
In contrast, the widespread use of fusion and implantation of interbody cages has limited advantages in back pain relief [22]. Our ranking analysis suggested differences in effectiveness among the groups. However, due to heterogeneity across the studies, a definitive conclusion regarding the absolute superiority of decompression plus fusion could not be drawn.
It is generally recognized that fusion surgery prolongs operation time and increases blood loss [23, 24]. The cost-analysis possibly shifted the balance in favor of decompression alone, as it was associated with lower treatment costs and resource savings. Complications were reported in almost all studies but seldom discussed entirely [8, 9, 16]. Reoperation, as a main complication, was linked with complexity and dissatisfaction. Our analysis found the reoperation rate comparable between decompression and added fusion procedures, with a slightly higher rate in the dynamic group.
A potential explanation lies in the specific failure modes of dynamic stabilization devices. While fusion-related reoperations often occur later due to adjacent segment disease or pseudoarthrosis, reoperations in the dynamic stabilization group may be driven by earlier-onset, device-specific complications such as screw loosening, breakage, or failure of the dynamic component itself [8, 18]. Furthermore, as a relatively newer technology compared to fusion, dynamic stabilization may have a steeper learning curve, and optimal patient selection criteria may still be evolving, potentially contributing to higher initial complication rates. The theoretical benefit of dynamic stabilization—preserving segmental motion to reduce stress on adjacent levels—remains a compelling concept for long-term spinal health. However, within the follow-up period of the included studies (up to 12 years), this potential benefit was not realized as a reduction in reoperations and was offset by the apparent implant-related risk. This suggests that the routine addition of dynamic stabilization to decompression for typical cases of low-grade degenerative spondylolisthesis may not be justified by current evidence.
This study has limitations, including small sample sizes and different complication reporting standards, which decreased statistical power and caused heterogeneity. Studies with follow-up exceeding 5 years were limited, which reduces the validity of the time-effect analysis.
In conclusion, our network meta-analysis found that decompression alone and decompression plus dynamic stabilization were non-inferior to decompression with fusion for degenerative spondylolisthesis, even over 12 years. Operation time and blood loss were significantly less in the decompression alone group. Considering the overall efficacy and potential cost-effectiveness, the addition of dynamic stabilization to decompression appears to offer little benefit, whereas decompression alone may be a sufficient and preferable treatment option for selected patients with degenerative spondylolisthesis.
Supplementary Information
Below is the link to the electronic supplementary material.
Authors' contributions
Conceptualization: Haiying Liu, Chen Guo, Shuai Xu; Data Curation: Shuai Xu, Chen Guo; Formal Analysis: Fengqi Liu, Chen Guo, Fengqi Liu; Investigation: Shuai Xu, Chen Guo; Methodology: Fengqi Liu,Chen Guo; Project Administration: Haiying Liu; Resources: Chen Guo; Fengqi Liu; Software: Chen Guo; Validation: Chen Guo; Visualization: Haiying Liu; Writing & Editing: Chen Guo.
Funding
(1) Clinical Medicine Plus X-Young Scholars Project Peking University, the Fundamental Research Funds for the Central Universities [grant number PKU2023LCXQ042], (2) the Beijing Natural Science Foundation [grant number 7232182], (3) Peking University Clinical Scientist Training Program (grant number BMU2024PYJH016), (4) China Association for Science and Technology: Innovative Service for Management of Scoliosis in Tibetan Adolescents (grant number: N/A), which is from Shuai Xu. National Natural Science Foundation of China [grant number 72074011], which is from Feng Sun.
Data availability
All data generated or analyzed during this study are included in this published article.
Declarations
Ethics approval
This study is a meta-analysis based on previously published data. No new human participants were involved in this study. Therefore, ethics approval and individual participant consent were not required.
Competing interests
There is no conflict of interest.
Footnotes
Shuai Xu and Feng Sun are co-corresponding authors.
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Chen Guo and Fengqi Liu contribute equally to this article.
Contributor Information
Feng Sun, Email: sunfeng@bjmu.edu.cn.
Shuai Xu, Email: xushuairmyy@pku.edu.cn.
References
- 1.Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the Maine lumbar spine study. Spine. 2000;25(5):556–62. [DOI] [PubMed] [Google Scholar]
- 2.Jacobsen S, Sonne-Holm S, Rovsing H, Monrad H, Gebuhr P. Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study. Spine. 2007;32(1):120–5. [DOI] [PubMed] [Google Scholar]
- 3.Kleinstueck FS, Fekete TF, Mannion AF, et al. To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer? Eur Spine J. 2012;21(2):268–75. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Choi CM, Chung JT, Lee SJ, Choi DJ. How I do it? Biportal endoscopic spinal surgery (BESS) for treatment of lumbar spinal stenosis. Acta Neurochir (Wien). 2016;158(3):459–63. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.van Grafhorst JMP, Dijkerman ML, Peul WC, Vleggeert-Lankamp CLA. Symptomatic lumbar stenosis due to low-grade degenerative spondylolisthesis can effectively be treated with mere decompression. Acta Neurochir (Wien). 2023;165(8):2145–51. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Matz PG, Meagher RJ, Lamer T, et al. Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. Spine J. 2016;16(3):439–48. [DOI] [PubMed] [Google Scholar]
- 7.Zhou L-P, Zhang R-J, Wang J-Q, et al. Medium and long-term radiographic and clinical outcomes of Dynesys dynamic stabilization versus instrumented fusion for degenerative lumbar spine diseases. BMC Surg. 2023;23(1):46. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Inose H, Kato T, Sasaki M, et al. Comparison of decompression, decompression plus fusion, and decompression plus stabilization: a long-term follow-up of a prospective, randomized study. Spine J. 2022;22(5):747–55. [DOI] [PubMed] [Google Scholar]
- 9.Azizpour K, Schutte P, Arts MP, et al. Decompression alone versus decompression and instrumented fusion for the treatment of isthmic spondylolisthesis: a randomized controlled trial. J Neurosurg Spine. 2021;35(6):687–97. [DOI] [PubMed] [Google Scholar]
- 10.Rouse B, Chaimani A, Li T. Network meta-analysis: an introduction for clinicians. Intern Emerg Med. 2017;12(1):103–11. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Försth P, Ólafsson G, Carlsson T, et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med. 2016;374(15):1413–23. [DOI] [PubMed] [Google Scholar]
- 12.Ghogawala Z, Resnick DK, Glassman SD, et al. Randomized controlled trials for degenerative lumbar spondylolisthesis: which patients benefit from lumbar fusion? J Neurosurg Spine. 2017;26(2):260–6. [DOI] [PubMed] [Google Scholar]
- 13.Bridwell KH, Sedgewick TA, O’Brien MF, Lenke LG, Baldus C. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord. 1993;6(6):461–72. [DOI] [PubMed] [Google Scholar]
- 14.Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am. 1991;73(6):802–8. [PubMed] [Google Scholar]
- 15.Davis RJ, Errico TJ, Bae H, Auerbach JD. Decompression and Coflex interlaminar stabilization compared with decompression and instrumented spinal fusion for spinal stenosis and low-grade degenerative spondylolisthesis two-year results from the prospective, randomized, multicenter, Food and Drug Administration investigational device exemption trial. Spine. 2013;38(18):1529–39. [DOI] [PubMed] [Google Scholar]
- 16.Austevoll IM, Hermansen E, Fagerland MW, et al. Decompression with or without Fusion in Degenerative Lumbar Spondylolisthesis. N Engl J Med. 2021;385(6):526–38. [DOI] [PubMed] [Google Scholar]
- 17.Austevoll IM, Hermansen E, Fagerland M, et al. Decompression alone versus decompression with instrumental fusion the NORDSTEN degenerative spondylolisthesis trial (NORDSTEN-DS); study protocol for a randomized controlled trial. BMC Musculoskelet Disord. 2019. 10.1186/s12891-018-2384-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Inose H, Kato T, Yuasa M, et al. Comparison of decompression, decompression plus fusion, and decompression plus stabilization for degenerative spondylolisthesis: a prospective, randomized study. Clin Spine Surg A Spine Publ. 2018;31(7):E347-e352. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Abdel-Fattah A, Bell F, Boden L, et al. 327 to fuse or not to fuse: the elderly patient with lumbar stenosis and low-grade spondylolisthesis. Systematic review and meta-analysis of randomised controlled trials. Br J Surg. 2022. 10.1093/bjs/znac268.003. [DOI] [PubMed] [Google Scholar]
- 20.Tozawa K, Matsubayashi Y, Kato S, et al. Surgical outcomes between posterior decompression alone and posterior decompression with fusion surgery among patients with Meyerding grade 2 degenerative spondylolisthesis: a multicenter cohort study. BMC Musculoskelet Disord. 2022;23(1):902. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Kobayashi Y, Tamai K, Toyoda H, et al. Clinical outcomes of minimally invasive posterior decompression for lumbar spinal stenosis with degenerative spondylolisthesis. Spine. 2021;46(18):1218–25. [DOI] [PubMed] [Google Scholar]
- 22.Wang W, Xiao B, Wang H, et al. Oblique lateral interbody fusion stand-alone vs. combined with percutaneous pedicle screw fixation in the treatment of discogenic low back pain. Front Surg. 2022. 10.3389/fsurg.2022.1013431. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Thomas K, Faris P, McIntosh G, et al. Decompression alone vs. decompression plus fusion for claudication secondary to lumbar spinal stenosis. Spine J. 2019;19(10):1633–9. [DOI] [PubMed] [Google Scholar]
- 24.Chan AK, Bisson EF, Bydon M, et al. A comparison of minimally invasive transforaminal lumbar interbody fusion and decompression alone for degenerative lumbar spondylolisthesis. Neurosurg Focus. 2019;46(5):E13. [DOI] [PubMed] [Google Scholar]
Associated Data
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Supplementary Materials
Data Availability Statement
All data generated or analyzed during this study are included in this published article.