Comparable long-term pain and disability outcomes following decompression alone versus decompression with fusion in lumbar spinal stenosis patients with high-signal facet joints

Abstract Purpose This study aimed to evaluate the long-term outcomes of decompressive surgery with or without fusion in patients with lumbar spinal stenosis (LSS) exhibiting high-signal facet joints, a radiological marker of potential instability. Methods A retrospective cohort study analysed surgeries performed by a single surgeon between January 2016 and June 2023. Eligible participants (n = 100) were adults with LSS who underwent decompression with or without fusion and were followed up using validated questionnaires to assess pain (VAS back, VAS leg) and disability (ODI, RMDQ). Statistical analyses included t-tests, ANOVA, and logistic regression to evaluate clinical outcomes. Results Fifty-seven patients underwent decompressive surgery (SD), and 43 underwent decompression with fusion (DF). DF patients were younger (67.67 vs. 73.07 years, p = 0.0008) and more likely to exhibit radiological markers of instability, including L5-S1 involvement ( p = 0.0315) and Grade 1 spondylolisthesis ( p = 0.0118). Both groups showed significant improvements in pain and disability scores ( p < 0.0001), with no significant differences between groups at follow-up. DF was associated with longer hospital stays (3.07 vs. 1.70 days, p < 0.0001) but fewer revision surgeries (2.33% vs. 15.79%, p = 0.0402). Higher BMI reduced odds of ODI improvement in the SD group ( p = 0.0252), while older age decreased the odds of RMDQ improvement in the DF group ( p = 0.0102). Conclusion Both surgical approaches yielded significant improvements in pain and disability for patients with LSS. The findings suggest fusion may not be necessary for patients with high-signal facet joints absent additional instability markers, supporting a tailored approach to surgical decision-making.