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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2026; 17(2): 113932
Published online Feb 18, 2026. doi: 10.5312/wjo.v17.i2.113932
Published online Feb 18, 2026. doi: 10.5312/wjo.v17.i2.113932
Laminectomy alone vs laminectomy with posterior fusion in lumbar spinal stenosis: The role of instability
Mikail Chatzivasiliadis, Nikolaos Gkantsinikoudis, Constantinos Chaniotakis, Krikor Gkoumousian, Stylianos Kapetanakis, Department of Spine and Deformities, European Interbalkan Medical Center, Thessaloniki 57001, Kentrikí Makedonía, Greece
Panagiotis Konstantinou, Department of Orthopaedic II, Medical School, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Gennimatas”, Thessaloniki 54635, Kentrikí Makedonía, Greece
Dimitrios Koulalis, Department of Orthopaedic I, National and Kapodistrian University of Athens, Athens 11527, Attikí, Greece
Lazaros Kostretzis, Department of Orthopaedics, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Kentrikí Makedonía, Greece
Stylianos Kapetanakis, Department of Orthopedics, Aristotle University, Thessaloniki 54124, Kentrikí Makedonía, Greece
Author contributions: Chatzivasiliadis M drafted the original manuscript; Konstantinou P, Koulalis D, Kostretzis L, Gkantsinikoudis N, Chaniotakis C, Gkoumousian K, and Kapetanakis S contributed to study design and data acquisition; Koulalis D, Kostretzis L, Gkantsinikoudis N, and Kapetanakis S performed the data analysis and interpretation. All authors critically revised the manuscript for important intellectual content and approved the final version.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Panagiotis Konstantinou, MD, Chief Physician, Department of Orthopaedic II, Medical School, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Gennimatas”, Ethnikis Aminis 41, Thessaloniki 54635, Kentrikí Makedonía, Greece. pkonsb@auth.gr
Received: September 9, 2025
Revised: October 15, 2025
Accepted: November 24, 2025
Published online: February 18, 2026
Processing time: 150 Days and 12.2 Hours
Revised: October 15, 2025
Accepted: November 24, 2025
Published online: February 18, 2026
Processing time: 150 Days and 12.2 Hours
Core Tip
Core Tip: Lumbar spinal stenosis is common in older adults, and laminectomy is the gold standard when surgery is required. The decision to add posterior fusion, however, is less clear when instability is not well defined. Spinal fusion is an irreversible intervention that permanently alters spinal biomechanics, making careful patient selection essential. This review explores the anatomical and biomechanical factors behind the controversy, the varying definitions of instability, and how these shape surgical practice. By comparing laminectomy alone with laminectomy plus fusion, we highlight current uncertainties and emphasize the need for clearer criteria and stronger evidence to guide surgeons in managing borderline cases.