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Introduction: Although osteoporosis and low bone mineral density is thought to lead to poor fusion outcomes, few studies have adequately addressed the correlation, and they were limited by small sample size at a single institution., Methods: We completed a secondary analysis of 182 patients enrolled at 26 spine centers across the United States in the EXO-SPINE FDA-approved clinical trial with 12-month CT-based fusion status determined by two independent, blinded radiologists. Using previously described CT-based techniques, we measured local and global Hounsfield units (HU) and examined the relationship with radiographic and clinical outcomes., Results: CT scans were available for review from 95 patients, with a mean age of 56.2 years and mean global density of 153.0 HU. No relationship was observed between HU and radiographic fusion status or clinical outcomes. Although 12% of patients had lumbar vertebral body HU measurements consistent with osteoporosis, this classification had no relation with fusion or clinical outcomes. Patients with pseudarthrosis had higher Oswestry Disability Index (22.2 vs. 16.6, P = 0.037) and back pain visual analog scale (7.0 vs. 4.9, P = 0.014) scores than patients with at least unilateral fusion at the 12-month follow-up., Discussion: In this large, multicenter study, lower vertebral body HU was not associated with worse fusion status after single-level instrumented posterolateral lumbar fusion using only local autologous bone graft. However, there was an association between radiographic fusion status and clinical outcomes, validating the importance of determining predictors of successful fusion. Assessment of fusion status with CT scans yielded a much lower fusion success rate with local bone graft than previously reported and may warrant additional investigation., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)

Study Design: Retrospective cohort study., Objective: Our objective was to determine whether lateral pedicle screw breach affects fusion rates and patient-reported outcomes in lumbar fusion surgery., Summary of Background Data: Although lateral pedicle screw malposition is considered relatively benign, few studies have focused specifically on clinical outcomes or fusion rates associated with lateral screw malposition., Methods: Twelve-month postoperative computed tomography scans were reviewed for lateral breach, severity of breach, and fusion status. Patients with lateral breach were compared with patients with no breach. Outcome measures included Numerical Pain Rating Scale for back and leg pain, Oswestry Disability Index, and SF-36 physical function (SF-36 PF). Multivariable linear and logistic regression and were adjusted for age, procedure, level, and/or baseline pain score., Results: Forty-five patients (31%) demonstrated 1 or more lateral breaches as compared with 99 patients without breach. After adjusting for baseline scores and fusion level, patients with 2 or more screw breaches experienced SF-36 PF score improvements that were 3.43 points less ( P =0.016) than patients with no lateral breach. After adjusting for baseline Numerical Pain Rating Scale, there was also a significant decrease in the odds of achieving minimally clinical important difference in back pain relief in these patients. There was no observed effect of lateral breach on the odds of successful fusion., Conclusions: The current study did not observe an association between laterally malpositioned pedicle screws and nonunion. However, results are consistent with a negative effect on SF-36 PF scores and self-reported back pain at 12 months., Competing Interests: K.C.B. has received nonfinancial research support from Arthrex, DJO Global and Zimmer Biomet, as well as grants from DePuy Synthes and Stryker Spine. R.C.S. has received grants from Smith and Nephew, he has consulted for NuVasive and has received royalty payments from Medtronic. D.K.P. has consulted for Stryler, Arthrex, Solco Spine, Aegis Spine and Hans Biomedical. J.S.F. has consulted for Stryker and FzioMed. R.W.H. has received royalty payments from NuVasive, has stock ownership in Aclarion and has consulted for Medtronic, Bioventus, and DePuy Synthes. The remaining authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: Retrospective, multicenter review of 96 patients who underwent L5-S1 interbody fusions through either a standard anterior retroperitoneal approach or using a novel device inserted through the presacral space (AxiaLIF) in conjunction with supplemental posterior fixation between 2002 and 2010., Objective: To compare the radiographic fusion rates and adverse events associated with anterior lumbar interbody fusion (ALIF) and AxiaLIF techniques., Summary of Background Data: Interbody fusions of the lumbosacral spine are frequently performed to provide anterior column support, increase the amount of surface area for bone formation, and facilitate deformity reduction. A number of different surgical approaches have been developed for this purpose including minimally invasive techniques., Materials and Methods: Patient information and procedural data were obtained from hospital charts. Multiplanar computed tomography images were evaluated by 2 independent observers to assess fusion success at 24 months using a 4-point grading scale. In addition to reviewing the medical records to identify any complications, all of the sites were queried regarding any device-related adverse events that may have occurred., Results: According to the radiographic analysis, the arthrodesis rates recorded for the ALIF and AxiaLIF cohorts were 79% and 85%, respectively (P>0.05). The numbers and types of adverse events recorded for these procedures appeared to be similar although there was 1 serious intraoperative complication (iliac artery laceration) noted in the ALIF group., Conclusions: The radiographic success and adverse events associated with AxiaLIF appear to be similar to that observed for ALIF, suggesting that this technique represents a safe and effective method for achieving an interbody fusion across the L5-S1 disk space when utilized in conjunction with posterior fixation.

Object: Although smoking has been shown to negatively affect fusion rates in patients undergoing multilevel fusions of the cervical and lumbar spine, the effect of smoking on fusion rates in patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with allograft and plate fixation has yet to be thoroughly investigated. The objective of the present study was to address the effect of smoking on fusion rates in patients undergoing a 1-level ACDF with allograft and a locked anterior cervical plate., Methods: This study is composed of patients from the control groups of 5 separate studies evaluating the use of an anterior cervical disc replacement to treat cervical radiculopathy. For each of the 5 studies the control group consisted of patients who underwent a 1-level ACDF with allograft and a locked cervical plate. The authors of the present study reviewed data obtained in a total of 573 patients; 156 patients were smokers and 417 were nonsmokers. A minimum follow-up period of 24 months was required for inclusion in this study. Fusion status was assessed by independent observers using lateral, neutral, and flexion/extension radiographs., Results: An overall fusion rate of 91.4% was achieved in all 573 patients. A solid fusion was shown in 382 patients (91.6%) who were nonsmokers. Among patients who were smokers, 142 (91.0%) had radiographic evidence of a solid fusion. A 2-tailed Fisher exact test revealed a p value of 0.867, indicating no difference in the union rates between smokers and nonsmokers., Conclusions: The authors found no statistically significant difference in fusion status between smokers and nonsmokers who underwent a single-level ACDF with allograft and a locked anterior cervical plate. Although the authors do not promote tobacco use, it appears that the use of allograft with a locked cervical plate in single-level ACDF among smokers produces similar fusion rates as it does in their nonsmoking counterparts.

Background Context: Posterior spine fusion is associated with significant intra- and postoperative blood losses. When referring to the total blood loss during spine surgery, the standard is to measure the intraoperative bleeding plus the postoperative drainage. This ignores the "hidden" blood loss that was found to be significant in other fields of surgery., Purpose: The purpose of this study was to examine whether posterior spine fusion carries a substantial hidden blood loss., Study Design/setting: A prospective study., Patient Sample: We prospectively studied 114 patients undergoing instrumented posterior spinal fusion at one center between January 2011 and April 2011., Outcome Measures: Total blood loss, visible blood loss, and hidden blood loss., Methods: For each patient, the hidden blood loss was calculated by deducting the observed perioperative blood loss from the calculated total blood loss based on the hematocrit changes. We compared the percentage of the hidden blood loss out of the total blood loss for primary versus revision posterior spine fusion., Results: Primary decompression and posterior fusion patients had a mean total true loss of 1,439 mL. Their calculated hidden loss was 600 mL, 42% of the total loss. After revision posterior spinal fusion surgery, the mean total blood loss was 1,606 mL. The mean visible loss was 975 mL, and the mean hidden loss was 631 mL, 39% of the total loss. Thus, there was no statistical difference in the hidden blood loss between primary and revision posterior spinal fusion surgeries (p>.05). We did not find a significant difference in the percentage of the hidden blood loss between patients who underwent one, two, or three or more levels of surgery., Conclusions: After posterior spinal fusion, there may be a large amount of the hidden blood loss., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Study Design: A subanalysis study., Objective: To compare surgical outcomes and complications of multilevel decompression and single-level fusion with multilevel decompression and multilevel fusion for patients with multilevel lumbar stenosis and single-level degenerative spondylolisthesis (DS)., Summary of Background Data: In patients with DS who are treated surgically, decompression and fusion provide a better clinical outcome than decompression alone. Surgical treatment for multilevel lumbar stenosis and DS typically includes decompression and fusion of the spondylolisthesis segment and decompression with or without fusion for the other stenotic segments. To date, no study has compared the results of these 2 surgical options for single-level DS with multilevel stenosis., Methods: The results from a multicenter randomized and observational study, the Spine Patient Outcomes Research Trial comparing multilevel decompression and single-level fusion and multilevel decompression and multilevel fusion for spinal stenosis with spondylolisthesis, were analyzed. The primary outcome measures were the bodily pain and physical function scales of the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and the modified Oswestry Disability Index at 1, 2, 3, and 4 years postoperatively. Secondary analysis consisted of stenosis bothersomeness index, low back pain bothersomeness, leg pain, patient satisfaction, and self-rated progress., Results: Overall, 207 patients were enrolled for the study, 130 had multlilevel decompression with 1 level fusion and 77 patients had multilevel decompression and multilevel fusion. For all primary and secondary outcome measures, there were no statistically significant differences in surgical outcomes between the 2 surgical techniques. However, operative time and intraoperative blood loss were significantly higher in the multilevel fusion group., Conclusion: Decompression and single-level fusion and decompression and multilevel fusion provide similar outcomes in patients with multilevel lumbar stenosis and single-level DS.

Study Design: Prospective cohort., Objective: To determine whether preoperative radiographic parameters (translation, angular motion, and lateral disc height) can predict fusion status in patients with degenerative spondylolisthesis who underwent a single-level decompression and non-instrumented posterolateral fusion using autogenous iliac crest bone graft., Summary of Background Data: Non-instrumented posterolateral fusion is sometimes considered in patients with degenerative spondylolisthesis who do not have radiographic evidence of instability. No previous study has attempted to determine whether preoperative radiographic parameters can be used to predict successful fusion., Methods: A prospective, randomized, controlled, multicenter clinical study was previously conducted to compare the outcomes of osteogenic protein 1 (BMP-7) putty to autogenous iliac crest bone graft for single-level non-instrumented posterolateral fusion for the treatment of symptomatic degenerative spondylolisthesis with spinal stenosis. A total of 90 patients who were randomized to the autograft group formed the basis of this study, 67 of whom had data on the 3 radiographic parameters. Preoperative and postoperative radiographs were evaluated by 2 independent observers. The spine was determined to be fused if there was presence of continuous bone bridging between the transverse processes, an angulation of ≤5°, and a translational movement of ≤3 mm on flexion/extension radiographs of the affected level., Results: Forty-two (63%) of the 67 patients had a radiographic fusion. The mean preoperative translation in this group was 1.87 mm (range, 0.3-7.35 mm), the angular motion was 4.44° (range, 0.1°-12.1°), and the lateral disc height was 8.74 mm (range, 0.2-15.34 mm). Twenty-five (37%) of the 67 patients had a radiographic pseudarthrosis. The mean preoperative translation in the pseudarthrosis group was 1.20 mm (range, 0-3.55 mm), the angular motion was 4.66° (range, 1.1°-12.95°), and the lateral disc space height was 8.10 mm (range, 1.98-13.315 mm). There was no significant difference in these 3 parameters between the fusion and the pseudarthrosis group., Conclusion: These results indicate that preoperative radiographic parameters that may indicate the absence of gross instability in degenerative spondylolisthesis are not reliable in predicting radiographic fusion in a single-level non-instrumented fusion.

Study Design: Randomized controlled trial comparing OP-1 (rhBMP-7) with iliac crest autograft in patients with symptomatic degenerative spondylolisthesis and spinal stenosis treated with decompression and uninstrumented posterolateral arthrodesis., Objective: To determine the safety and the clinical and radiographic efficacy of OP-1 (rhBMP-7) Putty as compared with an iliac crest bone autograft control in uninstrumented, single-level posterolateral spinal arthrodesis., Summary of Background Data: Preclinical and preliminary clinical data have demonstrated successful fusion and clinical outcomes with the use of OP-1 Putty in posterolateral spinal arthrodesis. No prior randomized controlled trial with adequate study power has been performed., Methods: A total of 335 patients were randomized in 2:1 fashion to receive either OP-1 Putty or autograft in the setting of an uninstrumented posterolateral arthrodesis performed for degenerative spondylolisthesis and symptomatic spinal stenosis. Patients were observed serially with radiographs, clinical examinations, and appropriate clinical indicators, including ODI, Short-Form 36, and visual analog scale scores. Serum samples were examined at regular intervals to assess the presence of antibodies to OP-1. The primary end point, Overall Success, was analyzed at 24 months. The study was extended to include additional imaging data and long-term clinical follow-up at 36+ months. At the 36+ month time point, CT scans were obtained in addition to plain radiographs to evaluate the presence and location of new bone formation. Modified Overall Success, including improvements in ODI, absence of retreatment, neurologic success, absence of device-related serious adverse events, angulation and translation success, and new bone formation by CT scan (at 36+ months), was then calculated using the 24-month primary clinical endpoints, updated retreatment data, and CT imaging and radiographic end points., Results: OP-1 Putty was demonstrated to be statistically equivalent to autograft with respect to the primary end point of modified overall success. The use of OP-1 Putty when compared to autograft was associated with statistically lower intraoperative blood loss and shorter operative times. Although patients in the OP-1 Putty group demonstrated an early propensity for formation of anti-OP-1 antibodies, this resolved completely in all patients with no clinical sequelae., Conclusion: OP-1 Putty is a safe and effective alternative to autograft in the setting of uninstrumented posterolateral spinal arthrodesis performed for degenerative spondylolisthesis and symptomatic spinal stenosis.

Background Context: Although autogenous bone is still considered to be the gold standard graft material for promoting spinal fusion, other bone graft substitutes have been developed in an attempt to improve arthrodesis rates and avoid the complications associated with the procurement of autograft. The bone morphogenetic proteins (BMPs) represent a family of osteoinductive growth factors that are known to stimulate the osteoblastic differentiation of stem cells. Osteogenic protein-1 (OP-1) Putty is a commercially available BMP preparation that is already approved for use in humans. Previous clinical studies involving patients with degenerative spondylolisthesis have reported that the efficacy and safety of OP-1 Putty is comparable to that of autograft at both 1- and 2-year follow-up., Purpose: The purpose of this study was to evaluate the intermediate-term efficacy and safety of OP-1 Putty as an alternative to autogenous bone by comparing the 4-year radiographic, clinical, and safety data of these same patients who underwent decompression and uninstrumented fusion with either OP-1 Putty or iliac crest autograft., Study Design/setting: A prospective, randomized, controlled, multicenter clinical pilot study., Patient Sample: Thirty-six patients undergoing decompressive laminectomy and single-level uninstrumented fusion for degenerative spondylolisthesis and symptomatic spinal stenosis were randomized in a 2:1 fashion to receive either OP-1 Putty (24 patients) or autogenous iliac crest bone graft (12 patients)., Outcome Measures: Patient-reported outcome measures consisting of Oswestry Disability Index and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) scores were used to evaluate clinical efficacy. Perioperative data including operative time, estimated blood loss, and duration of hospital stay were also recorded for each surgery. Postoperatively, a neurological examination and an assessment of donor-site pain (if applicable) were performed at every follow-up visit. Radiographic fusion success was defined as the presence of continuous bridging bone formation between the transverse processes at the level of the spondylolisthesis with minimal motion evident on dynamic lateral x-ray films. The primary efficacy endpoint was the overall success rate, a composite measure derived from both radiographic and clinical parameters. The safety of OP-1 Putty was confirmed by comparing the nature and frequency of all adverse events and complications that were prospectively observed in either of the groups., Methods: Thirty-six patients with degenerative spondylolisthesis and symptoms of neurogenic claudication underwent decompressive laminectomy and single-level uninstrumented fusion with either OP-1 Putty or autograft. All patients were evaluated at 6 weeks and 3, 6, 9, 12, and 24 months, after which time they were instructed to return on a yearly basis. Multiple neuroradiologists blinded to the assigned treatment reviewed static and dynamic X-ray films with digital calipers to assess fusion status according to the presence of continuous bridging bone across the transverse processes as well as the amount of residual motion evident at the level of interest. Oswestry Disability Index surveys and SF-36 questionnaires were used to assess clinical outcomes., Results: At the 48-month time point, complete radiographic and clinical data were available for 22 of 36 patients (16 OP-1 Putty and 6 autograft) and 25 of 36 patients (18 OP-1 Putty and 7 autograft), respectively. Radiographic evidence of a solid arthrodesis was present in 11 of 16 OP-1 Putty patients (68.8%) and 3 of 6 autograft patients (50%). Clinically successful outcomes defined as at least a 20% improvement in preoperative Oswestry scores were experienced by 14 of 19 OP-1 Putty patients (73.7%) and 4 of 7 autograft patients (57.1%); these clinical findings were corroborated by similar increases in SF-36 scores. The respective overall success rates of the OP-1 Putty and autograft group were 62.5% and 33.3%. In this study, there were no incidents of local or systemic toxicity, ectopic bone production, or other adverse events directly related to the use of OP-1 Putty., Conclusion: Despite the challenges associated with obtaining a solid uninstrumented fusion in patients with degenerative spondylolisthesis, the rates of radiographic fusion, clinical improvement, and overall success associated with the use of OP-1 Putty were at least comparable to that of the autograft controls for at least 48 months after surgery. These results appear to validate the short-term results previously reported for OP-1 Putty and suggest that this material may potentially represent a viable bone graft substitute for certain fusion applications.

Background Context: In 1965, Marshall Urist discovered that the extracellular matrix of bone contains the ability to induce new bone formation. This substance was later named bone morphogenetic protein (BMP). Since that time, BMPs have been extensively studied. Molecular clones have since been characterized and expressed as complementary DNAs (cDNAs). BMPs have recently been used in a multitude of mammalian clinical studies, including many recent human studies, for the purpose of evaluating their function in bone healing and spinal arthrodesis. BMPs are currently the most effective substitute available for bone graft as a means to eliminate the morbidity of iliac crest bone graft harvest and increase the rate of successful spinal arthrodesis., Purpose: The purpose of this article is to review the history and recent advancements in the use of BMPs in spinal arthrodesis models, as well as discuss the possible future use of BMPs in this clinical setting., Study Design/setting: The setting of this review article is centered on classic and recent literature of BMPs with emphasis on anterior as well as posterolateral spinal arthrodesis., Methods: The classic and recent primary literature about BMPS and their clinical use in human and nonhuman mammals for spinal fusion was reviewed. Special emphasis is placed on animal and human studies of both recombinant human bone morphogenetic protein-2 (rhBMP-2) and recombinant human osteogenic protein-1 (rhOP-1, rhBMP-7)., Results: BMPs are able to promote solid fusion in the spine in both the anterior and the posterolateral environments in animal studies and early human trials. Human trials to date have also shown an acceptable safety profile with the clinical use of these proteins., Conclusions: Animal studies and early human trials of BMPs support the ability of these growth factors to enhance or replace autograft bone for spinal arthrodesis. Studies have shown this promotion of fusion in both the anterior interbody and the posterolateral environments. Future use of these factors is likely to continue to expand in clinical as well as research arenas.

Study Design: A prospective, randomized study on patients who underwent posterior lumbar decompression with bilateral posterolateral arthrodesis., Objective: To determine the long-term influence of pseudarthrosis on the clinical outcome of patients with degenerative spondylolisthesis and spinal stenosis., Summary of Background Data: Spinal decompression and posterolateral arthrodesis have been shown to be beneficial in the surgical treatment of symptomatic spinal stenosis with concurrent spondylolisthesis., Methods: Forty-seven patients with single-level symptomatic spinal stenosis and spondylolisthesis were prospectively studied. Patients were treated with posterior decompression and bilateral posterolateral arthrodesis with autogenous bone graft. Radiographic evaluation was used to determine if fusion or pseudarthrosis was present. The solid fusion and pseudarthrosis groups were analyzed clinically, roentgenographically, and with a validated self-administered spinal stenosis questionnaire., Results: Forty-seven patients were available for review at a range of follow-up from 5 to 14 years. Average follow-up was 7 years 8 months. Clinical outcome was excellent to good in 86% of patients with a solid arthrodesis and in 56% of patients with a pseudarthrosis (P = 0.01). Significant differences in residual back and lower limb pain was discovered between the two groups using a scale ranging from 0 (no pain) to 5 (severe pain). Preoperative back and lower limb pain scores were statistically similar between the two groups. The solid fusion group performed significantly better in the symptom severity and physical function categories on the self-administered questionnaire. The two groups had similar results in the patient satisfaction category of this questionnaire., Conclusions: In patients undergoing single-level decompression and posterolateral arthrodesis for spinal stenosis and concurrent spondylolisthesis, a solid fusion improves long-term clinical results. Benefits of a successful arthrodesis over pseudarthrosis were demonstrated with respect to back and lower limb symptomatology compared with prior shorter-term studies, which indicated no significant difference in clinical outcome between the two groups.

Background Context: Bone grafting is used to augment bone healing and provide stability after spinal surgery. Autologous bone graft is limited in quantity and unfortunately associated with increased surgical time and donor-site morbidity. Alternatives to bone grafting in spinal surgery include the use of allografts, osteoinductive growth factors such as bone morphogenetic proteins and various synthetic osteoconductive carriers., Purpose: Recent research has provided insight into methods that may modulate the bone healing process at the cellular level in addition to reversing the effects of symptomatic disc degeneration, which is a potentially disabling condition, managed frequently with various fusion procedures. With many adjuncts and alternatives available for use in spinal surgery, a concise review of the current bone grafting alternatives in spinal surgery is necessary., Study Design/setting: A systematic review of the contemporary English literature on bone grafting in spinal surgery, including abstract information presented at national meetings., Methods: Bone grafting alternatives were reviewed as to their efficacy in extending or replacing autologous bone graft sources in spinal applications., Results: Alternatives to autologous bone graft include allograft bone, demineralized bone matrix, recombinant growth factors and synthetic implants. Each of these alternatives could possibly be combined with autologous bone marrow or various growth factors. Although none of the presently available substitutes provides all three of the fundamental properties of autograft bone (osteogenicity, osteoconductivity and osteoinductivity), there are a number of situations in which they have proven clinically useful., Conclusions: Alternatives to autogenous bone grafting find their greatest appeal when autograft bone is limited in supply or when acceptable rates of fusion may be achieved with these substitutes (or extenders) despite the absence of one or more of the properties of autologous bone graft. In these clinical situations, the morbidity of autograft harvest is reasonably avoided. Future research may discover that combinations of materials may cumulatively result in the expression of osteogenesis, osteoinductivity and osteoconductivity found in autogenous sources.

Degenerative spondylolisthesis (DS) with lumbar spinal stenosis (LSS) is commonly treated with decompression and fusion. The LimiFlex Dynamic Sagittal Tether (DST) is an investigational stabilization device for patients with DS and LSS. Assess return to work (RTW) and activities of daily living (ADL) receiving either decompression and DST stabilization (D+DST) or decompression and transforaminal lumbar interbody fusion (D+TLIF). Interim analysis from a multicenter, concurrently controlled study. Patients undergoing treatment (D+DST or D+TLIF) of Grade I Meyerding lumbar DS. Propensity score (PS) selected patients with 12-month follow-up were included. Time to RTW and activities of daily living, as well as Oswestry disability index (ODI). PS-selected IDE study subjects with 12 months of follow-up were included in this analysis. Study records queried for work status preoperatively and at 12 months, as well as time to RTW and ADL, and change in disability (Oswestry Disability Index; ODI) at 12 months vs preop. Outcomes were compared using student's t-tests. PS-selected subjects totaled 267 (136 D+DST, 131 D+TLIF). Preoperatively, 49% of D+DST and 43% of D+TLIF subjects were working (p=0.14) and 7% D+DST and 11% D+TLIF were not working due to spinal condition (NWSC) (p=0.13). At 12 months postop, 44% of D+DST and 34% of D+TLIF subjects were working (p=0.05) and 2% D+DST and 10% D+TLIF were NWSC (p<0.01). Proportion of D+DST NWSC was significantly lower 12 months postop compared to preop (p=0.02). Mean±SD RTW time for D+DST/D+TLIF subjects was 5.4±6.6/11.8±9.6 weeks (p<0.01) and return to ADL time was 5.5±6.5/10.0±9.5 weeks (p<0.01). Mean±SD reduction in disability at 12 months from baseline was 38.1±18.4 for the D+DST group and 31.8±20.7 for the D+TLIF group (p<0.01) with effect sizes of -2.1 and -1.5, respectively. The primary objective of surgery for symptomatic DS is resolution of symptoms so patients can return to their normal ADL and work. Both D+DST and D+TLIF treated patients demonstrated a significant reduction in disability at 12-month follow-up. Significantly faster RTW and ADL were observed for D+DST compared to D+TLIF patients, by an average of more than 5 weeks. The proportion of D+DST patients NWSC was significantly less than at 12 months. Results indicate a significant advantage of earlier recovery for the D+DST patients allowing earlier RTW and earlier increase in ADLs compared to D+TLIF, with similar or greater improvements in disability after one year for patients treated with decompression and stabilization for symptomatic DS. Longer-term follow-up assessment with propensity score-adjusted outcomes will demonstrate whether this advantage and long-term outcomes are durable and generalizable. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]