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Försth 2016 — added fusion versus decompression alone

One-paragraph summary

The Swedish trial randomized 247 adults aged 50–80 with one- or two-level lumbar stenosis to decompression plus fusion or decompression alone, stratified by degenerative spondylolisthesis. At two years, mean ODI was 27 with fusion and 24 with decompression alone (P=0.24); six-minute walk distance was 397 versus 405 m (P=0.72). Hospital stay was 7.4 versus 4.1 days, and additional lumbar surgery occurred in 22% versus 21% over mean 6.5-year follow-up (Försth 2016, PMID 27074066).

Key findings

  • Added fusion did not improve ODI or six-minute walk distance.
  • Results were similar with and without baseline degenerative spondylolisthesis.
  • Fusion increased hospitalization, operating time, bleeding and cost.
  • Repeat surgery was nearly identical: 22% versus 21%.

Limitations

  • Findings do not exclude benefit in narrowly defined deformity or instability subgroups.
  • Surgical technique and length-of-stay norms may differ across systems and eras.
  • The trial tested routine addition of fusion, not every reconstructive indication.

Why it matters

It displaced spondylolisthesis as an automatic fusion trigger and made procedural burden part of the comparative result.

Cited by wiki pages

  • Overview
  • Lumbar decompression
  • Decompression versus fusion
  • Clinical trials landscape