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Jamal Bech Bouknaitir, Leah Y. Carreon, Stig Brorson, and Mikkel Østerheden Andersen

-reported outcome measures (PROMs). 10 , 11 In contrast, little is known about sagittal balance after decompression alone in spinal stenosis patients. Theoretically, decompression of the spinal neural structures alone should lead to improvement in sagittal balance. Spinal sagittal imbalance is not traditionally addressed when treating LSS patients and may be a factor that contributes to continuous disability and back pain if imbalance persists after decompression. Only a few studies have focused on change in sagittal balance after decompression alone. Retrospective studies

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Kayoumars Azizpour, Pieter Schutte, Mark P. Arts, Willem Pondaag, Gerrit J. Bouma, Maarten Coppes, Erik van Zwet, Wilco C. Peul, and Carmen L. A. Vleggeert-Lankamp

screw fixation and interbody fusion being the most advocated surgical techniques; 4–9 however, Gill and White advocated that additional fusion is not mandatory. 10 Previous studies evaluating noninstrumented decompression have demonstrated satisfactory results. 11–13 Although most spine surgeons perform decompression with instrumented fusion in isthmic spondylolisthesis, scientific justification for instrumented fusion over decompression alone is lacking. The main argument in favor of instrumented fusion is that upon reduction of the spondylolisthesis, the

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Andrew K. Chan, Erica F. Bisson, Mohamad Bydon, Steven D. Glassman, Kevin T. Foley, Eric A. Potts, Christopher I. Shaffrey, Mark E. Shaffrey, Domagoj Coric, John J. Knightly, Paul Park, Michael Y. Wang, Kai-Ming Fu, Jonathan R. Slotkin, Anthony L. Asher, Michael S. Virk, Panagiotis Kerezoudis, Mohammed Ali Alvi, Jian Guan, Regis W. Haid, and Praveen V. Mummaneni

, and ligamentous structures, which may lead to increased pain and destabilization of the spine. Disadvantages include a more technically demanding procedure with a learning curve and the lack of “open” visualization of bony and neural anatomy. Given the increasing prevalence of MIS, 12 a contemporaneous understanding of the effect of MIS fusion—compared with MIS decompression alone—for spondylolisthesis is of interest. To this end, we analyzed a prospective, multicenter, and multidisciplinary registry to compare outcomes following MIS transforaminal lumbar interbody

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Kenji Masuda, Takayuki Higashi, Katsutaka Yamada, Tatsuhiro Sekiya, and Tomoyuki Saito

radiographs. The purpose of this study was to compare the clinical and radiological results of decompression alone versus decompression with short fusion for mild DLS and to assess the usefulness of radiological parameters for surgical decision-making in these patients. Methods This study was approved by the ethics research board of the Yokohama City University School of Medicine. All patients provided informed consent for their participation in the study. From a total of 298 patients in whom we prospectively planned surgical treatment for degenerative lumbar disease

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Tomoaki Kinoshita, Isao Ohki, Kenneth R. Roth, Kageharu Amano, and Hideshige Moriya

flexion, which may represent how the interspinous—supraspinous ligaments are disrupted, is important in determining the indication for posterior decompression alone via the technique described here. Analysis of clinical outcomes suggests that patients with no or mild spinal instability can be quite successfully treated with this surgery. In patients with moderate spinal instability, it may provide a possible alternative treatment to other more invasive surgeries, particularly among geriatric or poor-risk patients. We have doubts as to the adequacy of this surgery in

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Abhijeet S. Barath, Osmond C. Wu, Mohit Patel, and Manish K. Kasliwal

very rare and the risk factors for recurrence and progression following previous decompressive surgeries remain poorly understood. Considering the possible role of biomechanical stress, the option of instrumented fusion may be entertained at the time of first recurrence following decompression alone so as to potentially avoid multiple recurrences, as was seen in the present case. Review of the images in our case shows the presence of anterior ankylosis at T3–4 where there was no OLF at presentation or recurrence of ossification after decompression. This further lends

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Mark W. Fox, Burton M. Onofrio, and Arlen D. Hanssen

decompression achieved at L-5, 120 at L-4, 62 at L-3, 16 at L-2, and two at L-1. Fourteen patients also had a discectomy. Two patients had L-5 discectomies, eight patients had L-4 discectomies, three patients had L-3 discectomies, and one patient had right L-3 and L-4 discectomies. Ninety-two patients (74%) underwent lumbar decompression alone, whereas 32 patients (26%) had a concomitant arthrodesis. All 32 arthrodeses were accomplished with posterolateral autogenous iliac crest bone grafting; 17 of the arthrodeses included supplementary pedicle screw and plate

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Meng Huang, Avery Buchholz, Anshit Goyal, Erica Bisson, Zoher Ghogawala, Eric Potts, John Knightly, Domagoj Coric, Anthony Asher, Kevin Foley, Praveen V. Mummaneni, Paul Park, Mark Shaffrey, Kai-Ming Fu, Jonathan Slotkin, Steven Glassman, Mohamad Bydon, and Michael Wang

decompression alone or decompression with supplemental fusion of the segment. While some studies have reported clinical equipoise when comparing decompression alone and with fusion, 9 , 10 there has been growing evidence in favor of supplemental fusion when treating the DLS population. 11–14 This has resulted in an increasing number of spinal fusions performed annually. 11 , 15–19 Still, there remains no standardized treatment guideline, and the threshold for incorporating fusion can vary depending on patient-, surgeon-, and site-specific factors. 20–22 As more emphasis

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Ikemefuna Onyekwelu, Steven D. Glassman, Anthony L. Asher, Christopher I. Shaffrey, Praveen V. Mummaneni, and Leah Y. Carreon

consistently demonstrated. 14 , 28 Despite the current lack of evidence, a tendency to favor less extensive, nonfusion procedures in obese patients is plausible given the historically higher postoperative complication rates associated with these patients. One possible reason for these higher rates could be that patients with higher BMIs are at risk for longer and more technically difficult procedures. 10 , 12 , 25 , 26 , 31 Decompression alone involves less time on the operating table and thus may be a preferred treatment strategy to lower risks. Given the previous

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Matthew J. McGirt, Frank J. Attenello, Ghazala Datoo, Muraya Gathinji, April Atiba, Jon D. Weingart, Benjamin Carson, and George I. Jallo

bone decompression of the posterior fossa and dural patch grafting (duraplasty). 9 , 17 Evidence for 83–100% symptom improvement with duraplasty has been reported in some series, depending on the patient population studied. 2 , 18 Authors of other studies have suggested that there is a subset of patients in whom bone decompression alone is adequate for symptom resolution. 15 , 21 These previous studies focus on decompression with primarily a single method, with few series directly comparing methods of decompression. Authors of comparison studies have suggested