Which country provides most of the research informing postoperative care timelines for decompression and instrumented fusion in grade I spondylolisthesis?

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Last updated: October 13, 2026 • View editorial policy

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Country of Research Origin

The majority of research informing postoperative care timelines for decompression and instrumented fusion in grade I spondylolisthesis originates from the United States.

Evidence Analysis

The primary guideline evidence 1 is based on the Spine Patient Outcomes Research Trial (SPORT), which was conducted in the United States and represents the largest prospective randomized investigation of this clinical question. The guideline authors (Resnick et al., published in Journal of Neurosurgery: Spine, 2014) explicitly reference multiple U.S.-based studies as the foundation for their recommendations.

Supporting Research Distribution

The research evidence shows a clear pattern:

  • United States dominance: The most recent and highest-quality evidence comes from U.S. databases and institutions 2, including the American College of Surgeons National Quality Improvement Program database (2015-2020) analyzing 4,120 patients, and the SpineCORe study group's Quality Outcomes Database 3

  • India: Two studies from Indian institutions 4, 5 examining functional outcomes in grade I spondylolisthesis, conducted in Karnataka (2015-2016) and involving smaller patient cohorts

  • International contributions: Additional research from various countries including network meta-analyses 6 drawing from multiple international sources

Clinical Context

The U.S.-based SPORT trial and subsequent analyses have been the most influential in shaping current practice patterns for this condition, particularly regarding the comparison of decompression alone versus decompression with fusion. The 2014 guidelines 1 synthesize predominantly North American surgical experience and outcomes data, making the United States the primary source of evidence for postoperative management protocols in grade I spondylolisthesis.

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References

6
Research

Evaluating surgical interventions for low-grade degenerative lumbar spondylolisthesis: a network meta-analysis of decompression alone, fusion, and dynamic stabilization.

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2025

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