Abstract

Lumbar spinal stenosis represents one of the most common indications for spinal surgery in adults. While decompressive laminectomy has been the cornerstone of surgical management for decades, there has been considerable debate regarding the necessity of adding instrumented fusion to achieve optimal outcomes. This literature review examines the current evidence comparing decompression alone versus decompression with fusion for lumbar spinal stenosis, with or without degenerative spondylolisthesis. Through a comprehensive search of three major databases (PubMed/MEDLINE, Cochrane Library, and Google Scholar), we identified and analysed high-quality evidence published between 2016 and 2025. This recent evidence consistently demonstrates that decompression alone achieves equivalent functional outcomes, neurological recovery (including improvement of neurogenic claudication and radiculopathy), pain relief, and patient satisfaction compared to decompression with fusion, while offering significant advantages in operative time, blood loss, hospitalization duration, and cost. Additionally, there is evidence to support a reduced incidence of adjacent segment disease in decompression alone versus decompression with fusion. These findings support a necessary paradigm shift toward decompression alone as the preferred surgical approach for most patients with lumbar spinal stenosis, reserving fusion for specific clinical indications supported by objective evidence of instability.

Keywords

laminectomy, spinal stenosis, decompression, fusion, spondylolisthesis, evidence-based medicine