Single-Level Versus Two-Level Decompression for Adjacent Segment Spinal Stenosis : A Spinal Canal Area-Matched...

Area of Science:

• Neurosurgery
• Spinal Surgery
• Orthopedic Surgery

Background:

• Surgeons debate single vs. multi-level decompression for multi-level lumbar stenosis.
• Existing studies show similar outcomes for single- and two-level decompression.
• No prior studies compared decompression groups considering upper adjacent level stenosis severity.

Purpose of the Study:

• To compare clinical outcomes of lumbar decompression without fusion.
• To match canal area between adjacent levels in one-level decompression and the upper level in two-level decompression.
• To evaluate reoperation rates and patient-reported outcomes.

Main Methods:

• Retrospective cohort study of 351 patients.
• Preoperative imaging assessed dural sac cross-sectional area (DSCSA) and spinopelvic parameters.
• 1:2 propensity score-matched analysis compared groups based on age, sex, comorbidity, and DSCSA.

Main Results:

• Overall reoperation rates were identical between single- and two-level decompression groups (21.2%).
• A trend towards higher reoperation at the upper adjacent level was observed in the single-level group (16.7% vs. 3.0%).
• Both groups showed similar improvements in patient-reported outcome measures (PROMs) and recovery patterns.

Conclusions:

• Single- and two-level decompression yield comparable clinical outcomes for patients with symptomatic single-level and adjacent radiographic stenosis.
• Two-level decompression might offer a reduced reoperation rate at the upper adjacent level.
• The findings suggest a potential benefit of two-level decompression in specific patient populations.