Point of view: a randomized, controlled trial of fusion surgery for lumbar spinal stenosis—lessons learnt and practical considerations
Lumbar spinal stenosis (LS) surgery is probably the most common spinal procedure performed for older adults in the world (1,2). Surgical treatment is well accepted for those patients with persistent symptoms of moderate or severe intensity (2,3). The rationale for surgical treatment is to decompress the nerves roots and, consequently, decreasing the intensity of symptoms. The main surgical procedure performed consists in a simple laminectomy with or without concomitant foraminotomy, depending on the location and the degree of nerve root compression. Development of modern spinal instrumentation (4) and the understanding of spino-pelvic relationships, as well as the great concern of a postoperative iatrogenic instability, lead to higher and crescent rates of spinal instrumentation in LS surgery: it is estimated that about 50% of the patients with LS alone received a concomitant instrumented fusion in the United States (5).