PMID- 36134108
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220924
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 14
IP  - 8
DP  - 2022 Aug
TI  - Does the Number of Levels of Decompression Have an Impact on the Clinical 
      Outcomes of Patients With Lumbar Degenerative Spondylolisthesis: A Retrospective 
      Study in Single-Level Fused Patients.
PG  - e27804
LID - 10.7759/cureus.27804 [doi]
LID - e27804
AB  - Introduction The American Association of Neurological Surgeons (AANS) and the 
      Congress of Neurological Surgeons (CNS) 2014 lumbar fusion guidelines for 
      stenosis with degenerative spondylolisthesis (DS) support surgical decompression 
      and fusion as an effective treatment option for symptomatic stenosis associated 
      with DS. The association between the number of levels decompressed in patients 
      with single-level fusion and clinical outcomes has never been published. Methods 
      A retrospective analysis of a single-center, prospectively collected database was 
      performed on 77 patients to compare the effect of the number of decompression 
      levels in patients that received single-level fusion surgery. A total of 77 
      patients met the criteria. Group one had one level decompressed, group two had 
      two levels decompressed, and group three had three or four levels decompressed. 
      All patients received lumbar fusion surgery at a single spinal level. Outcomes at 
      six months included: Substantial Clinical Benefit (SCB) (DeltaODI >/= 10 points); 
      Minimal Clinically Important Difference (MCID) (DeltaODI >/= 5); no MCID (DeltaODI <5 
      points). Student's t-tests, one-way analysis of variance (ANOVA), and post hoc 
      comparison using unpaired two-tailed student's t-test with Holm-Bonferroni 
      correction were performed. p -values were ranked from smallest to largest, and 
      alpha level adjustments were made.  Results A sub-analysis of each group's 
      clinical outcomes showed that patients with two levels decompressed reached 
      greater clinical outcomes. SCB was obtained by approximately 60% (group one: 
      12.5% vs. group three: 40%) of the patients. A total of 77.6% (38/49) achieved 
      MCID (group one: 62.5% vs. group three: 55%). Single-level fused patients with 
      two levels of decompression showed an improvement of 48% from baseline ODI, as 
      opposed to group one: 17.85% and group three: 21.1%. Patients belonging to group 
      two showed the lowest rate of no improvement. Baseline ODI scores were similar 
      upon presentation (p=0.46), and the difference was found among groups after six 
      months of follow-up (p=0.009). Post hoc comparison showed statistical 
      significance in the comparison between group two and group three (p=0.009, alpha 
      value: 0.017). Conclusion The addition of more than two levels of decompression 
      to single-level fused patients might be associated with poor clinical outcomes 
      and spinal instability.
CI  - Copyright (c) 2022, Gonzalez et al.
FAU - Gonzalez, Glenn A
AU  - Gonzalez GA
AD  - Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.
FAU - Franco, Daniel
AU  - Franco D
AD  - Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.
FAU - Porto, Guilherme
AU  - Porto G
AD  - Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.
FAU - Elia, Christopher
AU  - Elia C
AD  - Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.
FAU - Hattar, Ellina
AU  - Hattar E
AD  - Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.
FAU - Hines, Kevin
AU  - Hines K
AD  - Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.
FAU - Mahtabfar, Aria
AU  - Mahtabfar A
AD  - Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.
FAU - O'Leary, Matthew
AU  - O'Leary M
AD  - Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.
FAU - Philipp, Lucas
AU  - Philipp L
AD  - Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.
FAU - Atallah, Elias
AU  - Atallah E
AD  - Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.
FAU - Montenegro, Thiago S
AU  - Montenegro TS
AD  - Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.
FAU - Heller, Joshua
AU  - Heller J
AD  - Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.
FAU - Sharan, Ashwini
AU  - Sharan A
AD  - Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.
FAU - Jallo, Jack
AU  - Jallo J
AD  - Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.
FAU - Harrop, James
AU  - Harrop J
AD  - Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.
LA  - eng
PT  - Journal Article
DEP - 20220809
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC9481219
OTO - NOTNLM
OT  - decompression levels
OT  - degenerative spondylolisthesis
OT  - evidence-based medicine
OT  - lumbar fusion
OT  - odi
OT  - single-level fusion
COIS- The authors have declared that no competing interests exist.
EDAT- 2022/09/23 06:00
MHDA- 2022/09/23 06:01
PMCR- 2022/08/09
CRDT- 2022/09/22 04:05
PHST- 2022/08/09 00:00 [accepted]
PHST- 2022/09/22 04:05 [entrez]
PHST- 2022/09/23 06:00 [pubmed]
PHST- 2022/09/23 06:01 [medline]
PHST- 2022/08/09 00:00 [pmc-release]
AID - 10.7759/cureus.27804 [doi]
PST - epublish
SO  - Cureus. 2022 Aug 9;14(8):e27804. doi: 10.7759/cureus.27804. eCollection 2022 Aug.