Study design:

A retrospective analysis of prospectively collected data.

Objective:

To report the decision-making process for DA and DF at a tertiary orthopedic center and compare the operative outcomes between both groups.

Background:

Controversy exists around the optimal operative treatment for DLS, either with decompression and fusion (DF) or decompression alone (DA). Although previous studies tried to establish specific indications, clinical decision-making algorithms are needed.

Methods:

Patients undergoing spinal surgery for DLS at L4/5 were retrospectively analyzed. A survey of spine surgeons was performed to identify factors influencing surgical decision-making, and their association with the surgical procedure was tested in the clinical dataset. We then developed a clinical score based on the statistical analysis and survey results. The predictive capability of the score was tested in the clinical dataset with a ROC analysis. To evaluate the clinical outcome, two years follow-up postoperative Oswestry Disability Index (ODI), postoperative low back pain (LBP) (NAS), and patient satisfaction were compared between the DF and DA groups.

Results:

124 patients were included in the analysis; 66 received DF (53.2%) and 58 DA (46.8%). Both groups showed no significant differences in postoperative ODI, LBP, or satisfaction. The degree of spondylolisthesis, facet joint diastasis and effusion, sagittal disbalance, and severity of LBP were identified as the most important factors for deciding on DA or DF. The AUC of the decision-making score was 0.84. At a cut-off of 3 points indicating DF, the accuracy was 80.6%.

Conclusion:

The 2-year follow-up data showed that both groups showed similar improvement in ODI after both procedures, validating the respective decision. The developed score shows excellent predictive capabilities for the decision processes of different spine surgeons at a single tertiary center and highlights relevant clinical and radiographic parameters. Further studies are needed to assess the external applicability of these findings.