Outcomes of One Versus Two Level MIS Decompression With Adjacent Level Stenosis

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Lumbar spinal stenosis (LSS) is commonly treated with decompression surgery.
• Adjacent level disease is a frequent finding in LSS patients.
• Optimal surgical strategy for LSS with asymptomatic adjacent stenosis is debated.

Purpose of the Study:

• To compare clinical outcomes of single-level vs. dual-level minimally invasive decompression (MIS) for LSS.
• To evaluate if decompressing only the symptomatic level is sufficient in cases with adjacent stenosis.
• To assess complications and reoperation rates between single-level decompression (SLD) and dual-level decompression (DLD).

Main Methods:

• Retrospective cohort study of 148 patients undergoing primary MIS decompression for LSS.
• Patients with symptomatic single-level stenosis and adjacent level stenosis were analyzed.
• Comparison of outcomes between SLD (n=126) and DLD (n=76) using Schizas grading for stenosis severity.

Main Results:

• No significant differences in patient-reported outcomes up to 2 years postoperatively between SLD and DLD groups.
• Subgroup analysis of matched stenosis severity also showed equivalent outcomes.
• Dual-level decompression (DLD) had a significantly longer operative time (P < 0.001) without increased complications or reoperations.

Conclusions:

• Single-level MIS decompression is as effective as dual-level decompression for LSS patients with symptomatic single-level stenosis and adjacent level stenosis.
• The added operative time and potential risks of DLD may not be justified given equivalent outcomes.
• Symptomatic level decompression alone appears sufficient in this patient population.