Laminectomy alone vs laminectomy with posterior fusion in lumbar spinal stenosis: The role of instability

Table 2 Summary of differences between laminectomy alone and laminectomy with fusion for lumbar spinal stenosis

Feature	Laminectomy alone	Laminectomy + fusion
Surgical approach	Midline posterior exposure; removal of lamina ± partial medial facetectomy; LF excision; unilateral or bilateral decompression	Midline posterior exposure; decompression followed by pedicle screw instrumentation ± interbody cage placement
Extent of bone resection	Limited to lamina ± < 50% facet joint to preserve stability	Often requires > 50% facet joint resection, especially with TLIF; posterior elements partially or fully decorticated
Stability preservation	Preserves motion segment; relies on intact posterior tension band	Eliminates motion at treated level; restores or maintains alignment
Graft/implant use	None	Pedicle screws, rods, bone graft with/or interbody cage
Common variations	Central laminectomy with bilateral decompression; unilateral laminotomy with bilateral decompression (“crossover” technique)	PLF; TLIF for anterior column support
Intraoperative considerations	Minimize facet removal to reduce risk of instability	Ensure adequate fixation and graft placement; navigation or neuromonitoring often used

LF: Ligamentum flavum; TLIF: Transforaminal lumbar interbody fusion; PLF: Posterolateral fusion.