I know some people really need a fusion but in trying to make a decision about my own situation I found this interesting. I use AI to gather information. This is just an FYI obviously not relevant to anyone's specific situation.
• Utilization gap: Historic and current data show the U.S. performs far more back surgeries/fusions than Europe; drivers include payment, practice norms, medico-legal climate, and technology diffusion; watchdog analyses (e.g., Lown Institute) continue to flag overuse in Medicare.

WHEN FUSION IS INDICATED — EUROPEAN GUIDELINES

✅ Yes, consider fusion if:
- Unstable spondylolisthesis (symptomatic)
- Isthmic spondylolisthesis
- Loss of sagittal balance (deformity)
- Bilateral facetectomy >50%
- Adult scoliosis with stenosis
- Recurrent stenosis with instability

❌ No, fusion not needed if:
- Stable spine
- Only leg pain (no instability)
- Back pain without mechanical pattern
- Normal alignment
- Facet arthropathy alone