Table 3 Appraisal of arguments for and against a surgical technique

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]

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]

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]