Commentary on: Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis by Ghogawala Z, Dziura J, Butler WE, Dai F, Terrin N, Magge SN, et al. NEJM 2016;374 (15):1424-34.

BACKGROUND

How does an article involving only 66 patients randomized into two spinal surgical groups get into the New England Journal of Medicine? Nevertheless, this one did. The article by Ghogawala et al. entitled Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis, compared the efficacy/outcomes of pedicle/screw/rod instrumented posterolateral lumbar fusions vs. decompressions alone for treating lumbar stenosis with grade I degenerative spondylolisthesis (DS).

METHODS

They designed a randomized controlled study involving only 66 patients between the ages of 50-80 (average age: 67) with lumbar stenosis and stable DS (3-14 mm). Outcomes were measured utilizing the physical measures from the Short Form 36 (SF-36) up to 4 postoperative years, and the Oswestry Disability Index (ODI) upt to 2 postoperative years. Data were available for 86% of patients at 2, but only for 68% of the patients at 4 postoperative years.

RESULTS

At 2 postoperative years, SF-36 scores were higher for the instrumented patients (28 patients) vs. decompressed (29 patients) patients. However, the scores were comparable for both groups using the ODI at 4 years. SF-36 scores, however, remained higher for the 19 remaining instrumented patients. Additionally, reoperation rates were 14% for fusions and a staggering 34% for decompressions alone.

CONCLUSIONS

The authors concluded; laminectomy with fusion offered a "slightly greater but clinically meaningful improvement in overall physical health-related quality of life vs. laminectomy alone." Rather, it should have read there were no statistically significant differences between the two groups and an insufficient number of patients were included in the study at all stages.