Rates of decompression with fusion increased from 2010 to 2021 vs. decompression alone
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Key takeaways:
- Rates of decompression and fusion for degenerative spondylolisthesis had almost a 403% increase between 2010 and 2021.
- During the same period, rates of decompression alone had a near 90% increase.
Results showed rates of decompression with fusion for degenerative spondylolisthesis had a more than fourfold increase during the last decade vs. decompression alone, despite lower complication and revision risks with decompression alone.
“Even in the setting of evolving literature and better understanding of the biomechanics and long-term outcomes of degenerative spondylolisthesis, there seems to be a rising trend in decompressing and fusing these patients as opposed to proceeding forward with a decompression,” Ram Alluri, MD, a spine surgeon with Keck Medicine of the University of Southern California, told Healio about results presented at the North American Spine Society Annual Meeting.
Using the PearlDiver National database, Alluri and colleagues collected demographic and procedural data among 171,696 patients with degenerative spondylolisthesis who underwent lumbar decompression either with (n = 82,287) or without (n = 89,409) fusion between 2010 and 2021.
“After matching, if you look at the years between 2010 to 2021, there was a 403% increase in decompression with fusion vs. only about a 90% increase in just decompression,” Alluri said.
Results showed decompression alone had lower 5-year revision risks, fewer 30-day complications, surgical complications and medical complications. Researchers also found combined lumbar decompression and fusion had an increased risk of opioid use at 90- and 180-days postoperatively.
“From a health care standpoint, there is conflicting literature with regards to decompressing or decompressing and fusing patients with degenerative spondylolisthesis. While the literature is conflicting, we seem to still be proceeding forward with decompression and fusion,” Alluri said. “This [study] is a call to attention that, while there is evolving literature supporting doing a decompression, the practice patterns of spine surgeons in the United States demonstrate a clear — and rising — preference for fusion procedures in this patient population.”
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Ball J, et al. National trends in lumbar degenerative spondylolisthesis with stenosis treated with fusion vs. decompression. Presented at: North American Spine Society Annual Meeting; Sept. 25-28, 2024; Chicago.
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