Lumbar Spinal Stenosis is a degenerative condition  where compression of the spinal cord or nerve roots occur due to  narrowing of the spinal canal in the lumbar region ^1,2. It commonly affects elder  due to age related degenerative changes such as intervertebral disc bulging, facet joint hypertrophy, ligamentum flavum thickening, and osteophyte formation³.The prevalence of lumbar spinal stenosis increases with age .It has also  become an important cause of functional limitation and reduced quality of life in older adults. Patients commonly present with complaints such as low back pain, leg pain, numbness, weakness, and neurogenic claudication,  characterized by pain or heaviness in the legs during walking that is relieved by sitting or bending forward.⁴

Symptoms are often aggravated by standing or walking and relieved by sitting or spinal flexion. Clinical examination done with radiological evaluation helps in confirming the diagnosis and to assess  the severity of neural compression. Conservative treatment like analgesics, physiotherapy, lifestyle modification, and epidural steroid injections is done as an initial conservative method. However, when conservative treatment fails to provide adequate relief, surgical intervention becomes necessary. Decompressive lumbar laminectomy remains the gold standard surgical treatment for symptomatic lumbar spinal stenosis⁵. The  surgery is performed mainly to relieve pressure on the nerve roots so as to  improve pain, neurological symptoms, and functional capacity. Degenerative spondylolisthesis, excessive facet degeneration, and abnormal motion on dynamic radiographs are commonly considered indicators of instability.³ In patients with instability, decompression alone may increase the risk of postoperative progression of slip, recurrent symptoms, or persistent back pain. On the other hand, addition of posterior fusion increases operative duration, blood loss, hospital stay, implant-related complications, and overall treatment cost.⁶ Fusion can also alter normal spinal biomechanics and contribute to adjacent segment degeneration during long-term follow-up.Several studies have compared decompressive laminectomy alone with decompression combined with posterior fusion in lumbar spinal stenosis. Some studies have demonstrated superior functional outcomes and reduced reoperation rates with fusion in selected patients with instability, while others have reported comparable clinical outcomes between the two procedures. Considering the uncertainty regarding the role of fusion in lumbar spinal stenosis, the present study was undertaken to compare the clinical and functional outcomes of decompressive laminectomy alone versus decompressive laminectomy with posterior fusion.⁷ The study also aimed to evaluate operative parameters and postoperative complications associated with both procedures in patients undergoing surgical management for lumbar spinal stenosis.

AIM

To compare the functional and clinical outcomes of laminectomy alone versus laminectomy with posterior fusion in patients with Lumbar Spinal Stenosis.

This comparative observational study was conducted in the Department of Orthopaedics at a tertiary care center, from march 2025 to feb 2026. 68 patients diagnosed with Lumbar Spinal Stenosis were included. Patients presenting with complaints like low back pain, leg pain, motor weakness with radiological confirmation on MRI were included in our study. Studies involving patients with high-grade spondylolisthesis (grade III or higher), spinal trauma, tumors, infections, or inflammatory spinal disorders were excluded. The study population was divided into two groups. Group A underwent decompressive laminectomy alone, while Group B underwent decompressive laminectomy with posterior fusion . Patients having decompressive laminectomy alone included those who presented with leg pain or neurogenic claudication without spinal instability, deformity, or major spondylolisthesis. Decompression alone was preferred in these patients who have stable lumbar stenosis, including single level lumbar canal stenosis where neural decompression could be achieved without compromising spinal stability. Patients undergoing decompressive laminectomy with posterior fusion included those with degenerative spondylolisthesis, spinal instability, scoliosis, recurrent stenosis, significant deformity, or where extensive decompression can produce postoperative instability. Fusion was also considered in patients with predominant mechanical low back pain associated with instability. Detailed demographic and clinical data involving preoperative Visual Analogue Scale (VAS) score for back pain and leg pain, and Oswestry Disability Index (ODI) score were recorded prior to surgery. Operative parameters including duration of surgery, intraoperative blood loss, and duration of hospital stay were documented. Patients were followed for 12 months and functional outcomes via ODI and VAS scores were observed. Postoperative complications including surgical site infection, dural tear, neurological deterioration, implant-related complications, and revision surgery were also recorded .

Table 1. Demographic Profile of Study Population (n = 68)

The mean age was comparable between the groups (59.8 ± 8.4 vs. 61.2 ± 7.9 years), with a predominance of male patients (61.8% vs. 58.8%). BMI (26.4 ± 3.1 vs. 27.1 ± 3.5 kg/m²), prevalence of diabetes mellitus (32.4% vs. 35.3%), hypertension (44.1% vs. 50.0%), duration of symptoms (14.6 ± 5.8 vs. 15.2 ± 6.1 months), and smoking status (23.5% vs. 26.5%), indicating comparable preoperative profiles.

Table 2. Preoperative Clinical Characteristics

Neurogenic claudication, observed in 94.1% of patients in the laminectomy group and 97.1% in the fusion group, followed by radicular leg pain (88.2% vs. 85.3%) and low back pain (79.4% vs. 91.2%). Motor weakness was present in 26.5% and 32.4% of patients, while sensory symptoms were reported by 52.9% and 58.8% of patients in the respective groups.The mean ODI scores of 48.5 ± 8.2 and 50.7 ± 7.9. The mean preoperative VAS scores for back pain were 6.8 ± 1.3 and 7.4 ± 1.2, while mean VAS scores for leg pain were 7.2 ± 1.1 and 7.0 ± 1.4 in the laminectomy and fusion groups, respectively.

Table 3. Operative Parameters

The  mean operative time (102 ± 18 vs. 168 ± 24 minutes), lower intraoperative blood loss (180 ± 65 vs. 420 ± 110 ml), and a reduced mean hospital stay (4.1 ± 1.2 vs. 7.3 ± 2.1 days) compared with the fusion group. ICU admission was required in 5.9% of patients undergoing laminectomy alone and 17.6% of those undergoing fusion, while dural tear occurred in 8.8% and 11.8% of patients.

Table 4. Functional Outcome at 12 Months

 The mean postoperative ODI was 20.4 ± 6.1 in the laminectomy group and 18.2 ± 5.8 in the fusion group, with corresponding ODI improvements of 28.1 ± 7.4 and 32.5 ± 8.2 points, respectively.Improvement in VAS back pain scores was greater in the fusion group (4.6 ± 1.2) compared with the laminectomy group (3.1 ± 1.0), while improvement in leg pain was comparable between groups (5.0 ± 1.4 vs. 4.8 ± 1.3). Improved walking ability was reported by 82.4% and 88.2% of patients, and overall patient satisfaction was observed in 79.4% and 85.3% of patients in the laminectomy and fusion groups, respectively.

Table 5. Postoperative Complications

 surgical site infection reported in 5.9% of patients undergoing laminectomy alone and 11.8% of those undergoing fusion. Dural tear was observed in 8.8% and 11.8% of patients, while neurological deterioration occurred in 2.9% and 5.9% of patients in the respective groups.Fusion-specific complications included implant failure and adjacent segment disease were not observed in the laminectomy group. Reoperation was required in 11.8% of patients treated with laminectomy alone compared with 5.9% of those who underwent fusion.

The mean age ,gender and mean BMI were comparable in both groups. Diabetes mellitus was present in 32.4% of patients in the laminectomy group and 35.3% in the fusion group, while hypertension was seen in 44.1% and 50.0% of patients, respectively. The mean duration of symptoms before surgery was 14.6 ± 5.8 months in the laminectomy group and 15.2 ± 6.1 months in the fusion group, with similar proportions of smokers in both groups (23.5% vs. 26.5%).Similar findings were reported by Peter Försth et al8 with no significant differences between the two treatment groups in any of the preoperative variables, including general health. Neurogenic claudication was occurring in 94.1% of patients in the laminectomy group and 97.1% of those in the fusion group. Radicular leg pain was reported by 88.2% and 85.3% of patients, while low back pain was present in 79.4% and 91.2% respectively. Motor weakness and Sensory symptoms were also comparable The mean preoperative ODI scores were 48.5 ± 8.2 and 50.7 ± 7.9, while the mean preoperative VAS scores for back pain were 6.8 ± 1.3 and 7.4 ± 1.2, and for leg pain were 7.2 ± 1.1 and 7.0 ± 1.4 in the laminectomy and fusion groups, respectively, which is inconsistent with the Austevoll et al9 where Approximately 75% of the patients had leg pain for more than a year, and more than 80% had back pain for more than a year. The mean operative time and Mean intraoperative blood loss was less in laminectomy alone than in the fusion group.The average duration of hospital stay was 4.1 ± 1.2 days for laminectomy alone and 7.3 ± 2.1 days for patients who underwent fusion. ICU admission was required in 5.9% of patients in the laminectomy group compared with 17.6% in the fusion group. Dural tear was observed more in fusion as compared to laminectomy alone ,suggesting that fusion was associated with greater operative complexity and perioperative resource utilization.Ghogawala et al.10 also reported More blood loss and longer hospital stays occurred in the fusion group than in the decompression-alone group (P<0.001 for both comparisons). The cumulative rate of reoperation was 14% in the fusion group and 34% in the decompression-alone group (P=0.05). The mean postoperative ODI score was higher in the laminectomy group than fusion group, indicating slightly better functional status following fusion and The mean improvement in ODI was more for the fusion group. Improvement in back pain, as measured by the VAS score, was more in fusion while mean improvement in VAS leg pain scores was comparable between the two groups. Improved walking ability was 82.4% of patients in the laminectomy group and 88.2% in the fusion group, while overall patient satisfaction was reported by 79.4% and 85.3% of patients, respectively, suggesting favorable outcomes with both procedures and a slight advantage for fusion.Ahmed et al11. also performed a meta-analysis of randomized controlled trials , the authors concluded that decompression plus fusion is 3.5 times superior to decompression alone in terms of ODI and VAS for back pain and leg pain . Yavin et al.12 performed a meta-analysis on studies comparing nonoperative management, decompression alone, and decompression plus fusion for the degenerative lumbar disease. They concluded that improvements in pain, disability, and satisfaction were greatest in patients undergoing fusion for spondylolisthesis . Surgical site infection , Dural tear , Neurological deterioration was relatively more in the fusion group than laminectomy alone. Implant failure was observed only in the fusion group, affecting 5.9% of patients, while adjacent segment disease developed in 8.8% of fusion patients and was not seen following laminectomy alone. Reoperation was required in 11.8% of patients in the laminectomy group compared with 5.9% in the fusion group, which is inconsistent with Cheng H, et al13 who reported Eight articles(n = 2746 patients; 1275 in the D group (intervention group) and 1741 in the F group( comparison group) reported postoperative complications, which did not include changes in neurological function, only included infection, hematoma, or other systemic complications such as pneumonia, urine retention, etc. The results showed that the incidence of postoperative complications in D group was lower than that in F group (OR 0.89; 95% CI 0.56 to 1.41, P = 0.612; I² = 26.2%, p = 0.220)

This study concluded that laminectomy alone in single level lumbar canal stenosis and laminectomy with fusion in multilevel lumbar canal stenosis resulted in improvement in pain relief, functional status, and quality of life among patients with lumbar spinal stenosis. While laminectomy alone was associated with shorter operative time, lower blood loss, reduced hospital stay, and fewer procedure-related complications while fusion showed superior functional outcomes, greater improvement in ODI and VAS scores, better walking ability, higher patient satisfaction, and a lower reoperation rate. Therefore, laminectomy alone remains an effective and less invasive treatment option in single level lumbar canal stenosis, whereas the fusion provide additional clinical benefit in  patients in multilevel lumbar canal stenosis, particularly those requiring greater spinal stability. Based on the findings of our study, fusion provide superior long-term clinical outcomes compared with laminectomy alone, although treatment decisions should be individualized after considering patient characteristics, disease severity, surgical risks, and expected functional benefits.

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