Wednesday, September 26, 2018 10:35 AM – 12:00 PM Understanding Lumbar Stenosis/Spondylolisthesis: 14. Stability-preserving multilevel versus single-level decompression-only surgery for lumbar spinal stenosis: demographic patterns and outcomes

Abstract

BACKGROUND CONTEXT There has been debate on the stability, and thus clinical outcomes, of multilevel lumbar decompression-only surgeries compared to those undergoing a single-level procedure. In patients with single-level stenosis, laminectomy has long been considered the standard of surgical care, with generally favorable outcomes. However, there has been considerable debate regarding the optimal surgical approach for patients with multi-level spinal stenosis. While the addition of a posterior lumbar fusion has been supported for a number of patient populations (degenerative spondylolisthesis, degenerative scoliosis, pars defects with disc disease, symptomatic baseline instability), the merits of fusion in patients with only multi-level stenosis is still debated. PURPOSE The goal of this study was to compare patient outcomes following a multi-level versus a single-level stability-preserving decompression-only surgery for lumbar spinal stenosis. STUDY DESIGN/SETTING Retrospective cohort series. PATIENT SAMPLE We performed a retrospective cohort analysis of patients who underwent a primary lumbar laminectomy between 2009 and 2015 by one of two senior orthopedic spine surgeons for lumbar spinal stenosis. Patients were excluded from analysis if they had any previous lumbar surgery, an unstable spondylolisthesis, were under 18 years of age at the time of surgery, or had postoperative follow-up less than 3 months. Patients were divided into three groups based on the number of decompression levels: single-level, two-level, or three or more levels. OUTCOME MEASURES Patient reported outcomes were obtained in the form of Oswestry Disability Index (ODI) scores, Visual Analog Scales (VAS) scores for the back and leg, 12-Item Short Form Mental and Physical Survey (SF-12) scores, and the Veterans Rand 12-Item Health Mental and Physical Survey (VR-12) scores. METHODS Baseline patient characteristics were compared using chi-squared analysis and independent sample t tests for categorical and continuous data, respectively. Bivariate and multivariate regressions were subsequently used to compare clinical outcomes between procedure groups. Multivariate analyses controlled for differences in baseline patient characteristics. RESULTS Overall, 212 consecutive patients who fulfilled our inclusion criteria were assessed. Average follow-up was 24.14 months (range 3-78 months). There were 106 patients who underwent a single-level, 74 patients underwent a two-level, and 32 patients underwent a three- or more level laminectomy. The multi-level decompression patients were significantly older (3+ levels 67.9±8.7 years, 2-level 56.4±14.7 years, single-level 48.7±16.4 years; p CONCLUSIONS Patients undergoing decompression of three or more levels present with similar postoperative outcomes to those who undergo a single-level decompression for lumbar spinal stenosis. Despite concerns for instability following a multi-level decompression, re-operation rates are low and not significantly different when comparing the number of levels that underwent a stability-preserving lumbar decompression. Under specific clinical and radiographic criteria, a multi-level decompression of three or more levels appears to be a safe and effective procedure with acceptable outcomes at 2 years after surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.