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Table 3 Appraisal of arguments for and against a surgical technique

From: Arguments for the choice of surgical treatments in patients with lumbar spinal stenosis – a systematic appraisal of randomized controlled trials

Decompression alone for spinal stenosis
FOR AGAINST
Argument Reference Argument Reference
Bilateral and unilateral laminotomy for bilateral decompression: the success rates were as high as 90%. [16] increase or cause vertebral instability/spondylolisthesis progression after decompression alone + continuous motion of the stenotic segments may produce osteophytes as well as compression of the nerve roots [12,15,16],
Satisfactory results with decompressive laminectomy alone. [11]   
Results of simple decompression for degenerative spondylolisthesis have been excellent. [13]   
Decompression and fusion without instrumentation for spinal stenosis
FOR AGAINST
argument Reference Argument Reference
Significant improvement in clinical outcome [9] controversy regarding the role of simultaneous arthrodesis of the spine: undisturbed relative stability of the decompressed spine can be maintained with meticulous operative technique [12]
Results of posterolateral fusion for degenerative spondylolisthesis have been excellent. [13] it has been suggested that degenerative changes, such as osteophytes, decreased disc height, and calcified ligaments, increase the stability of the spine, thereby decreasing the need for an arthrodesis [12]
Posterolateral fusion with only bone graft noted high fusion rates [10] Indications for fusion in degenerative lumbar spondylolisthesis and spinal stenosis have remained unclear [11]
Noninstrumented posterolateral fusion has always been well-established and is done frequently [10,14]   
Decompression and fusion with instrumentation for spinal stenosis
FOR AGAINST
Argument Reference Argument Reference
Improve fusion rate + prevent spondylolisthesis progressionMay improve fusion rate and may decrease rehabilitation time and may improve patient outcome [9,10,14], 360° (circumferential) fusion: requires two surgeries, is expensive, and utilizes a great deal of health care resources [14]
360° (circumferential) fusion: high fusion rate and a high level of patient satisfaction“270°” fusion (ALIF plus transpedicular instrumentation without PLF): may be effective [14] Complications: device-related osteoporosis [10]
Semirigid systems have been advocated as a means of obtaining spinal stability without sacrificing vertebral body bone density [10]   
Pedicle screw fixation increases rigidity despite resection of the posterior elements [10]