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Thank you to all the authors, experts, and participants for an excellent discussion thus far! These two studies have contributed so much to an important question about a very common condition. I have a question about their economic and decision-making implications.

Currently, 96% of patients with lumbar spinal stenosis and spondylolisthesis undergo decompression with fusion in the US compared to approximately 30% in Sweden (according to an answer provided by Dr. Försth during another discussion). Dr. Försth noted that the proportion of fusions in Sweden decreased from >60% before 2012 to around 30% currently.

Given the ODI outcomes reported in both studies in addition to the economic data reported by Försth et al, should the results of these two trials decrease the rate of decompression with fusion in the US?

If so, how would you discuss the latest evidence with patients given the important SF-36 results provided by Ghogawala et al? If not, why not? Perhaps practice should not change until we have the results of definitive studies on the role instability performed with advanced imaging?