Better Functional Recovery After Single-Level Compared With Two-Level Posterolateral Lumbar Fusion

Area of Science:

• Orthopedics
• Neurosurgery
• Spine Surgery

Background:

• Posterolateral lumbar fusion (PLF) is a common procedure for spinal conditions.
• Existing research often compares single-level to multilevel PLF but lacks direct comparison between single-level and two-level PLF.
• Patient outcomes after single-level versus two-level instrumented PLF require further investigation.

Purpose of the Study:

• To prospectively compare outcomes between single-level and two-level instrumented PLF.
• To evaluate differences in radiologic outcomes, pain levels, disability, and quality of life.

Main Methods:

• Prospective cohort study involving 42 patients across nine US centers.
• Data collected included Visual Analog Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and 36-Item Short Form Survey version 2.0 (SF-36v2) for quality of life.
• Follow-up assessments were conducted at six weeks and three, six, 12, and 24 months post-surgery.

Main Results:

• Both single-level and two-level PLF demonstrated improvements in ODI, SF-36v2 Mental Component Score (MCS), and VAS pain scores by the first follow-up.
• Single-level PLF showed a statistically significant greater improvement in ODI (5.86 points) compared to two-level PLF.
• Fusion rates were comparable between groups, with surgeon CT evaluation showing 67.6% at 12 months and 94.1% at 24 months, and third-party evaluation showing 81.1% at 12 months and 86.5% at 24 months.

Conclusions:

• Single-level PLF is associated with better functional outcomes and higher patient satisfaction compared to two-level PLF.
• Both procedures yield similar fusion rates, pain reduction, and improvements in generic health-related quality of life.
• Both single-level and two-level PLF are effective in achieving high fusion rates and improving patient-reported outcomes.