Lumbar spinal stenosis (LSS) is one of the most common indications for surgery in the USA. The addition of instrumented fusion to decompression for the treatment of LSS has become common, but recent randomized controlled trials (RCTs) have produced percieved conflicting results with unclear clinical implications. This review seeks clarity through an analysis of available RCTs. We performed a search of the PubMed database for RCTs that directly addressed decompression vs. decompression and fusion for the surgical treatment of LSS. RCTs were screened and reviewed to compare content such as patient selection, pathology, radiographic criteria, and operative technique. Five RCTs resulted from our search and were included in our analysis. Two studies yielded class I data while three yielded class III data due to study design related issues. Heterogeneity between these studies is emphasized with regard to patient selection, LSS definition, spondylolisthesis, instability, and surgical technique. Efforts to decipher which patients will truly benefit from instrumented fusion for the surgical treatment of LSS are still ongoing. Surgeon judgment will remain a crucial component for surgical decision making until future trials provide clarity. Instrumented fusion should be tailored to the individual patient rather than incorporated as a routine practice.

中文翻译：

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对有症状的腰椎管狭窄症患者，应用器械融合术对减压进行补充是对现有随机对照试验的一项重要评估。

腰椎管狭窄症（LSS）是美国最常见的手术指征之一。减压中使用仪器融合技术治疗LSS已很普遍，但是最近的随机对照试验（RCT）产生了相互矛盾的结果，临床意义尚不清楚。通过对可用RCT的分析，本次审查寻求清晰性。我们在PubMed数据库中搜索了RCT，这些RCT直接解决了LSS的减压与减压和融合。筛选并审查了RCT，以比较诸如患者选择，病理学，影像学标准和手术技术等内容。我们的搜索得出了5个RCT，这些RCT也包含在我们的分析中。由于与研究设计相关的问题，两项研究获得了I类数据，而三项获得了III类数据。这些研究之间的异质性在患者选择，LSS定义，腰椎滑脱，不稳定性和手术技术方面得到强调。仍在努力研究哪些患者将真正受益于融合器械治疗LSS的手术。外科医生的判断将仍然是外科手术决策的重要组成部分，直到将来的试验更加明确为止。仪器化融合应针对个别患者量身定制，而不应作为常规做法纳入。外科医生的判断将仍然是外科手术决策的重要组成部分，直到未来的试验更加明确为止。仪器化融合应针对个别患者量身定制，而不应作为常规做法使用。外科医生的判断将仍然是外科手术决策的重要组成部分，直到将来的试验更加明确为止。仪器化融合应针对个别患者量身定制，而不应作为常规做法纳入。