Decompression With or Without Fusion Across Subgroups With Degenerative Lumbar Spondylolisthesis : A Target Trial Emulation.

In adults with lumbar degenerative spondylolisthesis undergoing decompression, adding fusion did not change 12-month Oswestry Disability Index versus decompression alone (mean difference 2.2; 95% CI -1.6 to 6.1).

• Why it matters: Prior randomized evidence shows limited benefit and higher risk from fusion, yet fusion use has grown; subgroup-specific comparative effectiveness remained uncertain.
• What they did: Using a target trial emulation cohort from the Norwegian Registry for Spine Surgery with NORDSTEN-DS, they compared decompression plus fusion versus decompression alone and estimated 12-month ODI and reoperation using inverse probability weighting.
• The result: Across prespecified subgroups (sex, age, smoking, BMI, back pain intensity, ASA grade), effects on ODI at 12 months were not different, and reoperation risk at 12 months did not differ.

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