Evidence-Based Recommendations for Spine Surgery

Alexander R. Vaccaro, MD, PhD, MBA; Charles G. Fisher, MD; Srinivas K. Prasad, MD; Alpesh A. Patel, MD, FACS; John Chi, MD, MPH; Kishore Mulpuri, MBBS, MHSc; Kenneth C. Thomas, MD, MHSc; Peter G. Whang, MD, FACS


Spine. 2020;45(21):E1441-E1448. 

In This Article

Recommendation Regarding Impact on Clinical Practice

This is a well-designed prospective, randomized, noninferiority trial that was intended to compare the outcomes of patients undergoing PLIF with either CS or PS. It has been proposed that CS may confer certain advantages relative to PS for which reason this fixation technique has already been adopted by many surgeons, in this study the authors did not identify any clinically meaningful or lasting differences between these cohorts at 2-year follow-up. Other prospective multicenter investigations are needed to better evaluate the safety and efficacy of CS and until this type of higher-quality evidence becomes available, we do not recommend the implementation of any changes to current clinical practice.

Schmidt S, Franke J, Rauschmann M, et al. Prospective, randomized multicenter study with 2-year follow-up to compare the performance of decompression with and without interlaminar stabilization. J Neurosurg Spine 2018; 28:406–415.

Lumbar stenosis with symptomatic neurogenic claudication is one of the most common indications for spinal surgery worldwide which generally involves some type of decompressive procedure ranging from traditional open laminectomy to novel minimally invasive strategies. In some instances where there are concerns about the development of recurrent stenosis or postoperative instability, a lumbar decompression may also be performed in conjunction with a fusion although there is recently published Level 1 data suggesting that a concomitant arthrodesis may not provide much incremental benefit compared with a decompression alone.[21] Schmidt et al[22] present the 2-year results of a prospective, randomized, controlled multicenter study comparing the outcomes of microsurgical decompression with or without interlaminar stabilization (ILS) using an implantable device as a treatment for symptomatic spinal stenosis.