{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:51:27Z","timestamp":1787755887134,"version":"build-2784847793"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"17","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,9,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>In Scandinavia, spinal fusion is frequently performed without instrumentation, as use of instrumentation in the elderly can be complicated by poor bone quality and the risk of screw pull-out. However, uninstrumented fusion carries the risk of nonunion. We performed a randomized controlled trial in an attempt to determine if use of instrumentation leads to better outcomes and fusion rates when spinal fusion is performed for degenerative spondylolisthesis in the elderly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This was a randomized, single-center, open-label trial of patients with symptomatic single-level degenerative spondylolisthesis who were assigned 1:1 to decompression and fusion with or without instrumentation after at least 12 weeks of nonoperative treatment had failed. The primary outcome was the change in the Oswestry Disability Index (ODI), and secondary outcomes included fusion rates within 1 year, reoperation rates within 2 years, and changes in the EuroQol-5 Dimension-3 Level (EQ-5D) score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Fifty-four subjects were randomized to each of the 2 groups, which had similar preoperative demographic and surgical characteristics. We found similar improvements in the ODI (p = 0.791), back pain, leg pain, and quality of life between groups at 1 and 2 years of follow-up. Solid fusion on computed tomography (CT) scans was noted in 94% of the patients in the instrumented group and 31% in the uninstrumented group (p &lt; 0.001). One patient (2%) in the instrumented group and 7 (13%) in the uninstrumented group (p = 0.031) had a reoperation within 2 years after the index surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>We found no difference in patient-reported outcomes when we compared instrumented with uninstrumented fusion in patients with degenerative spondylolisthesis. The uninstrumented group had a significantly higher rate of nonunion and reoperations at 2 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level I<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.22.00941","type":"journal-article","created":{"date-parts":[[2023,6,24]],"date-time":"2023-06-24T07:56:06Z","timestamp":1687593366000},"page":"1309-1317","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":12,"title":["Instrumented Versus Uninstrumented Posterolateral Fusion for Lumbar Spondylolisthesis"],"prefix":"10.2106","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1757-3302","authenticated-orcid":false,"given":"Andreas K.","family":"Andresen","sequence":"first","affiliation":[{"name":"Center for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark"},{"name":"Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark"},{"name":"Spine Centre of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3238-4259","authenticated-orcid":false,"given":"Line A.","family":"Wickstr\u00f8m","sequence":"additional","affiliation":[{"name":"Center for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark"},{"name":"Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2121-410X","authenticated-orcid":false,"given":"Randi B.","family":"Holm","sequence":"additional","affiliation":[{"name":"Center for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark"},{"name":"Spine Centre of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7685-9036","authenticated-orcid":false,"given":"Leah Y.","family":"Carreon","sequence":"additional","affiliation":[{"name":"Center for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark"},{"name":"Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8478-8218","authenticated-orcid":false,"given":"Mikkel \u00d8sterheden","family":"Andersen","sequence":"additional","affiliation":[{"name":"Center for Spine Surgery and Research, Lillebaelt Hospital, Middelfart, Denmark"},{"name":"Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark"},{"name":"Spine Centre of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,6,22]]},"reference":[{"issue":"24","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"43S","DOI":"10.1097\/00007632-199712151-00008","article-title":"Internal fixation in the osteoporotic spine","volume":"22","author":"Hu","year":"1997","journal-title":"Spine (Phila Pa 1976)."},{"issue":"8","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1016\/j.spinee.2017.03.019","article-title":"Complications and readmission after lumbar spine surgery in elderly patients: an analysis of 2,320 patients","volume":"17","author":"Saleh","year":"2017","journal-title":"Spine J."},{"issue":"5","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1097\/BRS.0000000000002822","article-title":"Trends in Lumbar Fusion Procedure Rates and Associated Hospital Costs for Degenerative Spinal Diseases in the United States, 2004 to 2015","volume":"44","author":"Martin","year":"2019","journal-title":"Spine (Phila Pa 1976)."},{"issue":"284","key":"bib4-20250430","first-page":"109","article-title":"Posterolateral lumbar and lumbosacral fusion with and without pedicle screw internal fixation","author":"Bernhardt","year":"1992","journal-title":"Clin Orthop Relat Res."},{"issue":"8","key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1097\/00007632-199306150-00006","article-title":"A prospective, randomized study of lumbar fusion. 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