What is the cost-effectiveness of adding fusion to decompression when treating degenerative lumbar spondylolisthesis?

One of the most treated spinal pathologies in the United States is degenerative lumbar spondylolisthesis. While many patients can be treated nonoperatively, some patients ultimately require operative intervention for relief of their symptoms. The optimal operative treatment for degenerative spondylolisthesis is controversial. As the debate regarding laminectomy or laminectomy and fusion remains undecided from a clinical standpoint, the cost of the adding an instrumented fusion to laminectomy may influence which procedure is favored over the long term for this disease process. In this chapter, we discuss randomized controlled trials which evaluate costs associated with laminectomy and fusion and more contemporary analyses which assess the cost of modern fusion technologies. While spinal fusion is often used to treat degenerative spondylolisthesis in the US, the cost-effectiveness of recent fusion technologies suggests that the addition of fusion may only be cost-effective in a specific subset of patients.