Patients Undergoing 3-Level-or-Greater Decompression-Only Surgery for Lumbar Spinal Stenosis Have Similar Outcomes to Those Undergoing Single-Level Surgery at 2 Years.

Autor:	Nolte MT; Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois., Louie PK; Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, New York., Basques BA; Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois., Varthi AG; Yale School of Medicine, Orthopaedics, and Rehabilitation, New Haven, Connecticut., Paul JC; OrthoConnecticut, Danbury, Connecticut., Khanna K; Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois., Khurana T; Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois., Chaudhri A; Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois., Samartzis D; Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois., Goldberg EJ; Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois., An HS; Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, Illinois.
Jazyk:	angličtina
Zdroj:	International journal of spine surgery [Int J Spine Surg] 2021 Oct; Vol. 15 (5), pp. 945-952. Date of Electronic Publication: 2021 Sep 22.
DOI:	10.14444/8124
Abstrakt:	Background: Stability following multilevel decompressive laminectomy without fusion has been debated using in vitro biomechanical and radiographic models. However, there is a lack of information regarding clinical outcomes for these patients. The aim of the present study was to determine the association between clinical outcomes and number of levels decompressed via laminectomy for treatment of lumbar spinal stenosis. Methods: We performed a retrospective cohort analysis of patients who underwent a primary lumbar laminectomy between 2009 and 2015 by senior orthopedic spine surgeons for lumbar spinal stenosis. Patients were divided into 2 groups based on the number of decompression levels: single level or 3 or more levels. Patient-reported outcomes were obtained in the form of Oswestry Disability Index (ODI) scores, visual analog scale (VAS) scores for the back and leg, 12-Item Short Form Mental and Physical Survey scores, and Veterans Rand 12-Item Health Mental and Physical Survey scores. Results: Overall, 138 consecutive patients were assessed, of which 106 underwent a single-level and 32 underwent a 3-or-more-level laminectomy. Average follow-up was 24.2 months. There were no significant differences in the preoperative VAS back, VAS leg, or ODI scores between the single-level laminectomy and 3-or-more-level laminectomy groups. Both groups of patients experienced significant improvements in these clinical outcomes postoperatively with no clinically significant difference in the degree of improvement. Reoperation rates were low and similar between the 2 groups. Conclusions: Patients undergoing decompression of 3 or more levels present with similar postoperative outcomes to those who undergo a single-level decompression for lumbar spinal stenosis. Under specific clinical and radiographic criteria, a multilevel decompression of 3 or more levels may be a safe and effective procedure with acceptable outcomes at 2 years after surgery. Level of Evidence: 3. (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2021 ISASS.)
Databáze:	MEDLINE
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