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The Wilcoxon signed-rank test for matched pairs evaluates the null hypothesis by combining the ranks of differences with their signs. It essentially tests whether the median of the differences in a population of matched pairs is zero. Since the test incorporates more information than the sign test, it generally yields more trustable conclusions. This test also does not require the data to follow a normal distribution, but two conditions must be met for it to be applicable: (1) the data must...
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Friedman's Two-Way Analysis of Variance by Ranks is a nonparametric test designed to identify differences across multiple test attempts when traditional assumptions of normality and equal variances do not apply. Unlike conventional ANOVA, which requires normally distributed data with equal variances, Friedman's test is ideal for ordinal or non-normally distributed data, making it particularly useful for analyzing dependent samples, such as matched subjects over time or repeated measures...
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This lesson introduces two critical methods in pharmacokinetics, the Wagner-Nelson and Loo-Riegelman methods, used for estimating the absorption rate constant (ka) for drugs administered via non-intravenous routes. The Wagner-Nelson method relates ka to the plasma concentration derived from the slope of a semilog percent unabsorbed time plot. However, it is limited to drugs with one-compartment kinetics and can be impacted by factors like gastrointestinal motility or enzymatic degradation.
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Differential leveling is a precise method in surveying used to determine the elevation difference between two points. Its primary goal is to establish accurate vertical measurements to create level surfaces or grade lines critical for designing and constructing infrastructures such as roads, bridges, and buildings.The procedure for differential leveling begins with setting up and leveling the instrument at a point where the benchmark can be seen. The level rod is held on the benchmark (BM), and...
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Is it Necessary to Fuse? A Propensity Score-Matched Analysis of One- Versus Two-Level Fusions With Multilevel

Tejas Subramanian1,2, Stephane Owusu Sarpong1, Takashi Hirase1

  • 1Hospital for Special Surgery, New York, NY, USA.

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|August 28, 2025
PubMed
Summary

One-level decompression and fusion (SLF) offers similar long-term results as two-level decompression and fusion (DLF) for lumbar degeneration. SLF also reduces complications and revision surgeries, suggesting selective fusion may improve construct longevity.

Keywords:
PROMsdecompressionfusionmulti leveloutcomes

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Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Spinal Surgery

Background:

  • The necessity of extending spinal fusion to all decompressed levels in multilevel degenerative lumbar pathology is debated.
  • Fusion provides stability but may be unnecessary for adjacent levels without specific indications, potentially impacting long-term outcomes.

Purpose of the Study:

  • To compare outcomes between one-level fusion with two-level decompression (SLF) and two-level fusion with two-level decompression (DLF) in degenerative lumbar conditions.
  • To evaluate if decompression alone at levels without clear fusion indications yields comparable results to extensive fusion.

Main Methods:

  • Retrospective cohort study design.
  • Propensity score matching of 43 SLF patients with 43 DLF patients undergoing lumbar decompression for degenerative conditions.
  • Comparison of patient-reported outcome measures (PROMs), complication rates, revision surgeries, and recovery kinetics.

Main Results:

  • Early follow-up (<6 months) showed better SF-12 PCS scores and VAS-leg MCID achievement in the SLF group.
  • Long-term outcomes (≥6 months) revealed no significant differences in ODI, VAS-back, VAS-leg, or SF-12 PCS between SLF and DLF groups.
  • The DLF group had a significantly higher postoperative complication rate (25.6% vs 7%) and required more revision surgeries.

Conclusions:

  • One-level fusion with two-level decompression (SLF) achieves similar long-term results to two-level fusion (DLF) for degenerative lumbar disease.
  • SLF demonstrates fewer revisions and adjacent segment symptoms, supporting the strategy of "saving" fusion levels when not clearly indicated.
  • Selective fusion may optimize the longevity of the spinal construct, warranting further research for patient selection criteria.