Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 5, pp 613–621 | Cite as

To fuse or not to fuse: a survey among members of the German Spine Society (DWG) regarding lumbar degenerative spondylolisthesis and spinal stenosis

  • Patrick StrubeEmail author
  • Michael Putzier
  • Jan Siewe
  • Sven Oliver Eicker
  • Marc Dreimann
  • Timo Zippelius
Orthopaedic Surgery



Surgical treatment methods for degenerative spondylolisthesis (decompression versus decompression and fusion) have been critically debated. The medical care situation is almost unknown for either treatment. Therefore, the aim of the present study was to provide information regarding the use of parameters for decision-making and the employment of surgical techniques.

Materials and methods

A web-based survey was performed among members of the German-Spine-Society (DWG). Information regarding participant characteristics (specialty, age, DWG certification status, number of spine surgeries performed at the participant’s institution each year, institutional status), estimates of the use of both treatment options, clinical and morphological decision-making criteria for additive fusion, and the surgical technique used was queried.


305 members (45% neurosurgeons/ 55% orthopedic or trauma surgeons) participated in the present study. The participants estimated that in 41.7% of the cases, decompression only was required, while 55.6% would benefit from additional fusion. Among the participants, 74% reported that low back pain was an important indicator of the need for fusion if the numerical rating scale for back pain was at least 6/10. The most commonly used decompression technique was minimally invasive unilateral laminotomy, whereas open approach-based interbody fusion with transpedicular fixation and laminotomy was the most frequently used fusion technique. Specialty, age, certification status, and institutional status had a partial effect on the responses regarding indications, treatment and surgical technique.


The present survey depicts the diversity of approaches to surgery for degenerative spondylolistheses in Germany. Considerable differences in treatment selection were observed in relation to the participants’ educational level and specialty.


Degenerative spondylolisthesis Fusion Decompression Indication Surgical technique Survey 



No funding was received for the present study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Brunner M, Schwarz T, Zeman F, König M, Grifka J, Benditz A (2018) Efficiency and predictive parameters of outcome of a multimodal pain management concept with spinal injections in patients with low back pain: a retrospective study of 445 patients. Arch Orthop Trauma Surg 138:901–909CrossRefGoogle Scholar
  2. 2.
    Weinstein JN, Lurie JD, Tosteson TD, Zhao W, Blood EA, Tosteson AN, Birkmeyer N, Herkowitz H, Longley M, Lenke L, Emery S, Hu SS (2009) Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. Four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am 91:1295–1304CrossRefGoogle Scholar
  3. 3.
    Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, Birkmeyer NJ, Hilibrand AS, Herkowitz H, Cammisa FP, Albert TJ, Emery SE, Lenke LG, Abdu WA, Longley M, Errico TJ, Hu SS (2007) Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 356:2257–2270CrossRefGoogle Scholar
  4. 4.
    Försth P, Olafsson G, Carlsson T, Frost A, Borgstrom F, Fritzell P, Ohagen P, Michaelsson K, Sanden B (2016) A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med 374:1413–1423CrossRefGoogle Scholar
  5. 5.
    Chun DS, Baker KC, Hsu WK (2015) Lumbar pseudarthrosis: a review of current diagnosis and treatment. Neurosurg Focus 39:E10CrossRefGoogle Scholar
  6. 6.
    Heo Y, Park JH, Seong HY, Lee YS, Jeon SR, Rhim SC, Roh SW (2015) Symptomatic adjacent segment degeneration at the L3-4 level after fusion surgery at the L4-5 level: evaluation of the risk factors and 10-year incidence. Eur Spine J 24:2474–2480CrossRefGoogle Scholar
  7. 7.
    Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE (2004) Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976) 29:1938–1944CrossRefGoogle Scholar
  8. 8.
    Lai PL, Chen LH, Niu CC, Fu TS, Chen WJ (2004) Relation between laminectomy and development of adjacent segment instability after lumbar fusion with pedicle fixation. Spine (Phila Pa 1976) 29:2527–2532CrossRefGoogle Scholar
  9. 9.
    Haddadi K, Ganjeh Qazvini HR (2016) Outcome after surgery of lumbar spinal stenosis: a randomized comparison of bilateral laminotomy, trumpet laminectomy, and conventional laminectomy. Front Surg 3:19CrossRefGoogle Scholar
  10. 10.
    Ghogawala Z, Dziura J, Butler WE, Dai F, Terrin N, Magge SN, Coumans JV, Harrington JF, Amin-Hanjani S, Schwartz JS, Sonntag VK, Barker FG 2nd, Benzel EC (2016) Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med 374:1424–1434CrossRefGoogle Scholar
  11. 11.
    Inui T, Murakami M, Nagao N, Miyazaki K, Matsuda K, Tominaga Y, Kitano M, Hasegawa H, Tominaga S (2017) Lumbar degenerative spondylolisthesis: changes in surgical indications and comparison of instrumented fusion with two surgical decompression procedures. Spine (Phila Pa 1976) 42:E15–E24CrossRefGoogle Scholar
  12. 12.
    Ahmad S, Hamad A, Bhalla A, Turner S, Balain B, Jaffray D (2017) The outcome of decompression alone for lumbar spinal stenosis with degenerative spondylolisthesis. Eur Spine J 26:414–419CrossRefGoogle Scholar
  13. 13.
    Cheung JP, Cheung PW, Cheung KM, Luk KD (2016) Decompression without fusion for low-grade degenerative spondylolisthesis. Asian Spine J 10:75–84CrossRefGoogle Scholar
  14. 14.
    Kepler CK, Vaccaro AR, Hilibrand AS, Anderson DG, Rihn JA, Albert TJ, Radcliff KE (2014) National trends in the use of fusion techniques to treat degenerative spondylolisthesis. Spine (Phila Pa 1976) 39:1584–1589CrossRefGoogle Scholar
  15. 15.
    Schroeder GD, Kepler CK, Kurd MF, Vaccaro AR, Hsu WK, Patel AA, Savage JW (2015) Rationale for the surgical treatment of lumbar degenerative spondylolisthesis. Spine (Phila Pa 1976) 40:E1161–E1166CrossRefGoogle Scholar
  16. 16.
    Joaquim AF, Milano JB, Ghizoni E, Patel AA (2016) Is there a role for decompression alone for treating symptomatic degenerative lumbar spondylolisthesis? A systematic review. Clin Spine Surg 29:191–202CrossRefGoogle Scholar
  17. 17.
    Blumenthal C, Curran J, Benzel EC, Potter R, Magge SN, Harrington JF Jr, Coumans JV, Ghogawala Z (2013) Radiographic predictors of delayed instability following decompression without fusion for degenerative grade I lumbar spondylolisthesis. J Neurosurg Spine 18:340–346CrossRefGoogle Scholar
  18. 18.
    Simmonds AM, Rampersaud YR, Dvorak MF, Dea N, Melnyk AD, Fisher CG (2015) Defining the inherent stability of degenerative spondylolisthesis: a systematic review. J Neurosurg Spine 23:178–189CrossRefGoogle Scholar
  19. 19.
    Iguchi T, Kanemura A, Kasahara K, Sato K, Kurihara A, Yoshiya S, Nishida K, Miyamoto H, Doita M (2004) Lumbar instability and clinical symptoms: which is the more critical factor for symptoms: sagittal translation or segment angulation? J Spinal Disord Tech 17:284–290CrossRefGoogle Scholar
  20. 20.
    Chang W, Yuwen P, Zhu Y, Wei N, Feng C, Zhang Y, Chen W (2017) Effectiveness of decompression alone versus decompression plus fusion for lumbar spinal stenosis: a systematic review and meta-analysis. Arch Orthop Trauma Surg 137:637–650CrossRefGoogle Scholar
  21. 21.
    Fairbank J, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R (2005) Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ 330:1233CrossRefGoogle Scholar
  22. 22.
    Bydon M, De la Garza-Ramos R, Macki M, Baker A, Gokaslan AK, Bydon A (2014) Lumbar fusion versus nonoperative management for treatment of discogenic low back pain: a systematic review and meta-analysis of randomized controlled trials. J Spinal Disord Tech 27:297–304CrossRefGoogle Scholar
  23. 23.
    Martin CR, Gruszczynski AT, Braunsfurth HA, Fallatah SM, O’Neil J, Wai EK (2007) The surgical management of degenerative lumbar spondylolisthesis: a systematic review. Spine (Phila Pa 1976) 32:1791–1798CrossRefGoogle Scholar
  24. 24.
    Hasegawa K, Shimoda H, Kitahara K, Sasaki K, Homma T (2011) What are the reliable radiological indicators of lumbar segmental instability? J Bone Joint Surg Br 93:650–657CrossRefGoogle Scholar
  25. 25.
    Snoddy MC, Sielatycki JA, Sivaganesan A, Engstrom SM, McGirt MJ, Devin CJ (2016) Can facet joint fluid on MRI and dynamic instability be a predictor of improvement in back pain following lumbar fusion for degenerative spondylolisthesis? Eur Spine J 25:2408–2415CrossRefGoogle Scholar
  26. 26.
    Donnarumma P, Tarantino R, Nigro L, Rullo M, Messina D, Diacinti D, Delfini R (2016) Decompression versus decompression and fusion for degenerative lumbar stenosis: analysis of the factors influencing the outcome of back pain and disability. J Spine Surg 2:52–58CrossRefGoogle Scholar
  27. 27.
    Sasai K, Umeda M, Maruyama T, Wakabayashi E, Iida H (2008) Microsurgical bilateral decompression via a unilateral approach for lumbar spinal canal stenosis including degenerative spondylolisthesis. J Neurosurg Spine 9:554–559CrossRefGoogle Scholar
  28. 28.
    Okuda S, Oda T, Miyauchi A, Tamura S, Hashimoto Y, Yamasaki S, Haku T, Kanematsu F, Ariga K, Ohwada T, Aono H, Hosono N, Fuji T, Iwasaki M (2008) Lamina horizontalization and facet tropism as the risk factors for adjacent segment degeneration after PLIF. Spine (Phila Pa 1976) 33:2754–2758CrossRefGoogle Scholar
  29. 29.
    Videbaek TS, Christensen FB, Soegaard R, Hansen ES, Hoy K, Helmig P, Niedermann B, Eiskjoer SP, Bunger CE (2006) Circumferential fusion improves outcome in comparison with instrumented posterolateral fusion: long-term results of a randomized clinical trial. Spine (Phila Pa 1976) 31:2875–2880CrossRefGoogle Scholar
  30. 30.
    Hoy K, Truong K, Andersen T, Bunger C (2017) Addition of TLIF does not improve outcome over standard posterior instrumented fusion. 5–10 years long-term Follow-up: results from a RCT. Eur Spine J 26:658–665CrossRefGoogle Scholar
  31. 31.
    Ha KY, Na KH, Shin JH, Kim KW (2008) Comparison of posterolateral fusion with and without additional posterior lumbar interbody fusion for degenerative lumbar spondylolisthesis. J Spinal Disord Tech 21:229–234CrossRefGoogle Scholar
  32. 32.
    Schöller K, Alimi M, Cong GT, Christos P, Härtl R (2017) Review and meta-analysis of secondary fusion rates following open vs minimally invasive decompression. Neurosurgery 80:355–367CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Orthopedic DepartmentUniversity Hospital JenaEisenbergGermany
  2. 2.Department of Traumatology and Orthopedics, Center for Musculoskeletal SurgeryCharité-Universitaetsmedizin BerlinBerlinGermany
  3. 3.Klinik und Poliklinik für Orthopädie und UnfallchirurgieUniversitätsklinikum Köln (AöR)CologneGermany
  4. 4.Department of NeurosurgeryUniversity Hospital Hamburg EppendorfHamburgGermany
  5. 5.Department of Trauma, Hand and Reconstructive SurgeryUniversity Hospital Hamburg EppendorfHamburgGermany

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