One Versus Three-Level Fusion in Patients Undergoing Multilevel Lumbar Decompression : Relative Perioperative Risks...

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Multilevel lumbar decompression may involve fusion at one or more levels.
• Clinical decisions regarding fusion extent (e.g., 1-level vs. all decompressed levels) impact patient outcomes.
• Understanding short-term and long-term implications of fusion extent is crucial.

Purpose of the Study:

• To compare perioperative complications, readmissions, and 5-year survival to reoperation.
• To assess outcomes for patients undergoing 3-level lumbar decompression with either 3-level fusion or 1-level fusion.

Main Methods:

• Retrospective cohort study utilizing the PearlDiver M165Orto database.
• Matched 1:1 analysis of patients undergoing 3-level lumbar decompression with either 3-level or 1-level fusion.
• Multivariable analysis to compare 90-day adverse events and 5-year survival to reoperation, controlling for age, sex, and Elixhauser Comorbidity Index.

Main Results:

• 3-level fusion was associated with significantly higher odds of 90-day adverse events (any, serious, minor) and readmissions compared to 1-level fusion.
• Odds ratios for aggregated adverse events were 1.42, serious adverse events 1.44, minor adverse events 1.42, and readmissions 1.51.
• Five-year survival to reoperation was significantly lower in the 3-level fusion group (P < 0.0001).

Conclusions:

• Patients undergoing 3-level lumbar decompression with 3-level fusion face increased risks of short-term complications, readmissions, and long-term reoperations.
• Data support selective fusion to indicated levels rather than matching fusion levels to decompression levels.
• This approach may improve patient outcomes following multilevel lumbar decompression.