Orthopaedic Surgery Resident Hospital for Special Surgery Hospital for Special Surgery
Introduction: Decompression for the treatment of lumbar spinal stenosis (LSS) has largely shown excellent clinical outcomes. Since it has been demonstrated compression on MRI does not correlate well to patient pain symptoms, optimal management of multilevel stenosis remains unclear. In patients with symptomatic single level stenosis and asymptomatic adjacent level disease, it is unknown whether decompressing only the symptomatic level is sufficient. This study compared outcomes between single level and dual level MIS decompression in these patients.
Methods: The current study is a retrospective review of patients undergoing primary single or dual level minimally invasive (MIS) decompression for the treatment of lumbar spinal stenosis. Radiographic stenosis severity was graded using the Schizas grading. Patients undergoing single level decompression (SLD) with moderate stenosis at the adjacent level were compared with patients undergoing dual level decompression (DLD) for multi-level LSS. Clinical outcomes, complications, and reoperations were compared between cohorts. Subgroup analysis was performed on patients with the same Schizas grade at the surgical level in the SLD group and the second surgical level in the DLD group.
Results: 148 patients were included (126 SLD, 76 DLD). There were no significant differences in patient reported outcomes between the two groups at any timepoint up to 2 years postoperatively, including in the matched stenosis severity subgroups. Operative time was longer in the DLD cohort (101 vs 74 min, p< 0.001). There were no significant differences in complications or reoperation rates.
Conclusion : In patients with single level symptomatic LSS and concordant adjacent level stenosis, decompression of only the symptomatic level provided equivalent clinical outcomes and reoperation rates compared to dual level decompression. The additional operative time and potential incremental risk of dual level surgery may not be justified in these patients.