Global Spine Journal · IF 2.6 · July 30, 2026 · LoE III
Elective Lumbar Decompression With Fusion Is Associated With Increased Mortality Compared With Decompression Alone: A National Propensity-Matched Analysis of Aging Cohorts
Alec Giakas, William A. Green, Mitchell K. Ng, Molly Milano, Yulia Lee, Anthony Castro, Jonathan Dalton, Brandon Martinazzi, Ali S. Farooqi, Daniel Gallagher, Eric Tecce, Alexandra Dionne — Rothman Institute
This retrospective database study used TriNetX to compare adults with degenerative lumbar disease (no instability) who had decompression alone versus decompression plus fusion, matching by age decade and frailty. Fusion was linked to much higher mortality at every time point studied, most strikingly a 30-day mortality of 4.19% versus 0.68% in octogenarians (OR 6.34), with the gap persisting out to two years (13.24% vs 4.61% in the 80s group).
AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing
Why it mattersThis raises a real concern for how surgeons counsel elderly patients about adding fusion to decompression when there is no clear structural indication like instability or deformity.
Conclusion strengthPotentially practice-changing
Registry cohort (adjusted): cannot support a practice change on its own.
Presenting this at rounds? Start here
- ?In an octogenarian with degenerative stenosis but no radiographic instability, how should this absolute mortality gap change the way you counsel about adding fusion versus doing decompression alone?
- ?If a patient has significant mechanical back pain suggesting possible occult instability not captured on imaging, how should surgeons balance the theoretical benefit of fusion against this study's mortality signal?