Fusion versus decompression surgery alone for lumbar degenerative spondylolisthesis: a comparative-effectiveness analysis and pragmatic health services assessment

Degenerative spondylolisthesis (DS) of the lumbar spine is one of the most common degenerative pathologies of the spine, with prevalence estimated between 19% and 43% depending on age and gender—it is more prevalent in the elderly and women. DS can cause both spinal instability and spinal stenosis, triggering low back pain and radiating pain to the lower extremities. With respect to the type of surgery, there is still no consensus on the optimal surgical strategy and debate remains as to whether decompression alone, consisting of the removal of portions of the dorsal bony and ligamentous structures, compared with decompression plus fusion (arthrodesis) results in clinically meaningful benefit and less harm to patients.

Objectives: Using data from the Swiss Lumbar Stenosis Outcome Study (LSOS), the aim of this study will be to evaluate the comparative effectiveness of decompression plus fusion surgery versus decompression alone in patients aged 50 years or more with degenerative spondylolisthesis (Meyerding I and II) over a long-term outcome of 3 years in the Swiss setting. We will complement this analysis with a pragmatic health services assessment that will compare the use of specific health resources (e.g., physical therapy and analgesics) in the two groups at 3 years.

Relevance: This project will provide valuable information about the expected benefit-harm assessment of these treatments in patients with degenerative spondylolisthesis requiring surgical intervention in Switzerland.