European Spine Journal

, Volume 26, Issue 2, pp 404–413 | Cite as

The effectiveness of decompression alone compared with additional fusion for lumbar spinal stenosis with degenerative spondylolisthesis: a pragmatic comparative non-inferiority observational study from the Norwegian Registry for Spine Surgery

  • Ivar M. AustevollEmail author
  • Rolf Gjestad
  • Jens Ivar Brox
  • Tore K. Solberg
  • Kjersti Storheim
  • Frode Rekeland
  • Erland Hermansen
  • Kari Indrekvam
  • Christian Hellum
Original Article



To evaluate the effect of adding fusion to decompression in patients operated for lumbar spinal stenosis with a concomitant lumbar degenerative spondylolisthesis.


After propensity score matching, 260 patients operated with decompression and fusion and 260 patients operated with decompression alone were compared. Primary outcome measures were leg and back pain [Numeric Rating Scale (NRS), 0–10] and Oswestry Disability Index (ODI, 0–100) at 12 months.


At 12-month follow-up, the fusion group rated their pain significantly lower than the decompression alone group [leg pain 3.0 and 3.6, respectively, mean difference −0.6, 95 % confidence interval (CI) −1.2 to −0.05, p = 0.03 and back pain 3.3 and 3.9, respectively, mean difference −0.6, 95 % CI −1.1 to −0.1, p = 0.02]. ODI was not significantly different between the groups (21.0 versus 23.3, mean difference −2.3, 95 % CI −5.8 to 1.1, p = 0.18). Seventy-four percent of the fusion group and 63 % of the decompression alone group achieved a clinically important improvement in back pain (difference in proportion of responders = 11 %, 95 % CI 2–20 %, p = 0.01), corresponding to a number needed to treat of 9 patients (95 % CI 5–50). There was no significant difference in responder rate for leg pain (74 and 67 %, respectively, difference 7 %, 95 % CI −1 to 16 %, p = 0.09) or for ODI (67 and 59 %, respectively, difference 8 %, 95 % CI 0–18 %, p = 0.06). The duration of surgery and hospital stay was longer for the fusion group (mean difference 68 min, 95 % CI 58–78, p < 0.01 and mean difference 4.2 days, 95 % CI 3.5–4.8, p < 0.01).


In the present non-inferiority study, we cannot conclude that decompression alone is as good as decompression with additional fusion. However, the small differences in the groups’ effect sizes suggest that a considerable number of patients can be treated with decompression alone. A challenge in future studies will be to find the best treatment option for each patient.


Lumbar spinal stenosis Degenerative spondylolisthesis Treatment Fusion 


Compliance with ethical standards


Helse Bergen HF, Haukeland University Hospital, Bergen, Norway.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Ivar M. Austevoll
    • 1
    Email author
  • Rolf Gjestad
    • 4
    • 5
  • Jens Ivar Brox
    • 6
  • Tore K. Solberg
    • 3
    • 7
  • Kjersti Storheim
    • 8
  • Frode Rekeland
    • 1
  • Erland Hermansen
    • 1
    • 2
    • 9
  • Kari Indrekvam
    • 1
    • 2
  • Christian Hellum
    • 3
    • 10
  1. 1.Kysthospitalet in Hagevik, Orthopedic ClinicHaukeland University HospitalBergenNorway
  2. 2.Department of Clinical MedicineUniversity of BergenBergenNorway
  3. 3.Norwegian Registry for Spine Surgery (NORspine)University Hospital of Northern NorwayTromsøNorway
  4. 4.Division of Mental Health CareHaukeland University HospitalBergenNorway
  5. 5.Centre for Research and Education in Forensic PsychiatryHaukeland University HospitalBergenNorway
  6. 6.Department of Physical Medicine and RehabilitationOslo University HospitalOsloNorway
  7. 7.Department of NeurosurgeryUniversity Hospital of Northern NorwayTromsøNorway
  8. 8.Communication and Research Unit for Musculoskeletal Disorders (FORMI)Oslo University Hospital, University of OsloOsloNorway
  9. 9.Department of Orthopedic SurgeryÅlesund Hospital, Møre and Romsdal Hospital TrustÅlesundNorway
  10. 10.Clinic for Surgery and Neurology, Department of OrthopedicsOslo University Hospital, University of OsloOsloNorway

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