Study Design
Retrospective comparative study.
Purpose
To evaluate and compare the clinical outcomes and complication profiles of decompression alone versus decompression with instrumented fusion in elderly patients aged 75 and older with lumbar spinal stenosis. Overview of Literature: Lumbar spinal stenosis is a common cause of disability in elderly patients. The decision between decompression alone and fusion surgery in the geriatric population remains controversial due to surgical risks and comorbidities.
Methods
A retrospective analysis of 121 patients aged ≥75 years treated either with laminectomy alone (n=60) or with posterior lumbar interbody fusion (PLIF, n=61) from April 2016 to December 2022. Baseline characteristics, perioperative parameters, and postoperative outcomes were compared.
Results
There were no significant differences in baseline characteristics. The PLIF group showed longer operative times, greater blood loss, and longer hospital stay, but similar complication rates. Both groups showed significant postoperative improvement in VAS, ODI, and EQ-5D scores.
Conclusions
Decompression alone and fusion surgery both provide substantial clinical benefit in elderly patients with spinal stenosis. With careful selection, fusion may be safely considered even in the elderly.

Background
Context: There are few reports of changes in global sagittal alignment and corresponding factors like hand grip strength (HGS) and muscle performance tests to detect changes in global sagittal alignment after surgery for lumbar spinal stenosis (LSS).
Purpose
The purpose of the study was to determine whether HGS can be a useful predictive marker of global sagittal alignment changes after decompression with fusion surgery for LSS. Study Design: This is a retrospective observational study. Patient Sample: Patients who underwent spine surgery for LSS were included in the present study. Outcome Measures: Radiological spinopelvic parameters including sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), global tilt (GT), and T1 pelvic angle (T1PA) were assessed. Clinical outcomes parameters like Oswestry Disability Index (ODI), Euro-QOL (EQ-5D), visual analog scale (VAS) scores for back or leg pain were assessed. To assess muscle performance, three functional mobility tests (6-meter walk test, timed up and go test, sit-to-stand test) and HGS were checked.
Materials and Methods
A total 91 consecutive patients who underwent spine fusion surgery for LSS were included. 1 year after posterior decompression and fusion surgery, the patients were further classified into four groups according to preoperative and postoperative SVA. We analyzed radiological parameters like SVA, LL, PT, PI, GT, and T1PA. The ODI, the EQ-5D and VAS scores for back or leg pain were recorded as clinical outcomes assessment. To assess muscle performance, SMT, TUGT, STS, and HGS were checked.
Results
HGS was significantly correlated with age, postoperative SVA, ODI, EQ-5D and muscle performance test. HGS was related with change of preoperative sagittal alignment 1yr after surgery. Using a receiver operating characteristic (ROC) curve to determine the cutoff values of HGS as predictors of postoperative balanced sagittal alignment according to SVA, cutoff value of HGS demonstrated 19.5 kg with a sensitivity of 82.1% and specificity of 66.7%.
Conclusion
Patients with non-balanced sagittal alignment in LSS demonstrated decreased muscle function and muscle strength. If the muscle strength was weak in the group in which the sagittal balance was maintained preoperatively, it could be converted to non-balanced sagittal alignment. Thus, preoperative HGS may be a good predictor of postoperative SVA change.

Purpose
of study: The purpose of this study is to understand the biomechanics of interspinous devices in lumbar spinal surgery and to review the effectiveness of the devices for lumbar spinal stenosis through recent related articles.
Materials and Methods
Medical databases were searched for the key words of interspinous device and lumbar spinal stenosis using PubMed from 2010 to the present.
Results
Several studies have shown sustained symptomatic improvements after interspinous device insertion. However, most of the prospective, randomized, double-blinded studies have shown that it is not superior to conventional laminectomy from a statistical perspective. Furthermore, interspinous device insertion has been shown to have a higher reoperation rate and to be less cost effective.
Conclusions
A large prospective cohort study with a longer follow-up period comparing decompressive surgery alone versus interspinous device insertion for the treatment of lumbar spinal stenosis is needed to conclusively determine whether the interspinous device is beneficial.