PMID- 38266826
OWN - NLM
STAT- Publisher
LR  - 20240208
IS  - 1878-1632 (Electronic)
IS  - 1529-9430 (Linking)
DP  - 2024 Jan 23
TI  - Do patients with lumbar spinal stenosis benefit from decompression of levels with 
      adjacent moderate stenosis? A prospective cohort study from the NORDSTEN study.
LID - S1529-9430(24)00017-2 [pii]
LID - 10.1016/j.spinee.2024.01.010 [doi]
AB  - BACKGROUND: Lumbar spinal stenosis (LSS) is characterized by pain that radiates 
      to the buttocks and/or legs, aggravated by walking and relieved by forward 
      flexion. There is poor correlation between clinical symptoms and severity of 
      stenosis on MRI, and multi-level stenosis has not been described to present worse 
      symptoms or treatment outcomes, compared with patients with single-level 
      stenosis. In patients with one level with severe stenosis combined with an 
      adjacent level with moderate stenosis, the surgeon must decide whether to 
      decompress only the narrowest level or both, to achieve the best possible 
      outcome. The potential benefits of performing surgery on an adjacent moderate 
      stenosis is debated, and the scientific evidence in scarce. PURPOSE: The aim of 
      the present study was to investigate whether patients with a level of adjacent 
      moderate stenosis, along with an index stenosis, benefitted from a dual-level 
      decompression (DLD) compared with a single-level decompression (SLD). 
      Furthermore, to investigate whether DLD patients had longer duration of surgery 
      and hospital stay, higher rates of complications and/or lower rate of 
      reoperations compared with SLD patients. STUDY DESIGN: Prospective cohort study. 
      PATIENT SAMPLE: We analyzed data from the Norwegian Degenerative Spondylisthesis 
      and Spinal Stenosis study- Spinal Stenosis Trial (NORDSTEN-SST). In this 
      randomized multicenter study, 437 patients were included, evaluating clinical 
      outcomes of three different surgical treatment options for LSS. Patients with 
      degenerative spondylolisthesis were excluded. METHOD: Based on preoperative MRI, 
      the present analysis included all patients who had a moderate stenosis (defined 
      as Schizas B or C) in addition to a predefined index stenosis (the level with the 
      smallest cross-sectional area). We compared patients who, based on the surgeons; 
      choice, received a dual-level decompression, with those receiving a single-level 
      decompression. OUTCOME MEASURES: The primary outcome was mean change in the 
      Oswestry Disability Index (ODI) score from baseline to 2-year follow up. 
      Secondary outcomes were proportion of success (30% reduction in ODI score), the 
      Numeric Rating Scales for back and leg pain (NRS), the EuroQol 5-dimensional 
      questionnaire utility index (EQ-5D), the Zurich Claudication Questionnaire (ZCQ), 
      the Global Perceived Effect (GPE)-scale, duration of surgery, duration of 
      hospital stay, perioperative complications and reoperation rates. RESULTS: Among 
      the 222 patients, included in the analysis, 108 underwent DLD and 114 underwent 
      SLD. There was no difference in change scores for any of the investigated 
      patient-reported outcomes between the groups after 2 years. However, the DLD 
      group had longer duration of surgery and longer length of hospital stay. There 
      was no difference in reoperation rates or perioperative complications. 
      CONCLUSION: This study, alongside the NORDSTEN-LSS trial on patients with 
      adjacent moderate stenosis as well as an index stenosis, showed no superior 
      clinical effectiveness for dual-level surgery compared with single-level surgery.
CI  - Copyright (c) 2024 The Author(s). Published by Elsevier Inc. All rights reserved.
FAU - Tronstad, Sara
AU  - Tronstad S
AD  - Department of Orthopedic Surgery, Skien Hospital, Skien, Norway. Electronic 
      address: tronstad.sara@gmail.com.
FAU - Haug, Knut Jorgen
AU  - Haug KJ
AD  - Department of Orthopedic Surgery, Skien Hospital, Skien, Norway.
FAU - Myklebust, Tor Age
AU  - Myklebust TA
AD  - Department of Research and Innovation, More and Romsdal Hospital Trust, Alesund, 
      Norway; Department of Registration, Cancer Registry Norway, Oslo, Norway.
FAU - Weber, Clemens
AU  - Weber C
AD  - Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway; 
      Department of Quality and Health Technology, University of Stavanger, Stavanger, 
      Norway.
FAU - Brisby, Helena
AU  - Brisby H
AD  - Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden; 
      Department of Orthopedics, Institute for Clinical Sciences, Sahlgrenska Academy, 
      University of Gothenburg, Gothenburg, Sweden.
FAU - Austevoll, Ivar Magne
AU  - Austevoll IM
AD  - Kysthospitalet in Hagevik. Orthopedic Clinic, Haukeland University Hospital, 
      Bergen, Norway.
FAU - Hellum, Christian
AU  - Hellum C
AD  - Division of Orthopedic Surgery, Oslo University Hospital Ulleval, Oslo, Norway.
FAU - Storheim, Kjersti
AU  - Storheim K
AD  - Communication and Research Unit for Musculoskeletal Health (FORMI), Oslo 
      University Hospital Oslo, Oslo, Norway.
FAU - Aaen, Jorn
AU  - Aaen J
AD  - Department of Orthopedic Surgery, Alesund Hospital, More og Romsdal Hospital 
      Trust, Alesund, Norway; Department of Circulation and Medical Imaging, Faculty of 
      Medicine and Health Sciences, Norwegian University of Science and Technology, 
      Trondheim, Norway.
FAU - Banitalebi, Hasan
AU  - Banitalebi H
AD  - Department of Diagnostic Imaging, Akershus University Hospital, Nordbyhagen, 
      Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
FAU - Brox, Jens Ivar
AU  - Brox JI
AD  - Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 
      Oslo, Norway.
FAU - Grundnes, Oliver
AU  - Grundnes O
AD  - Department of Orthopedics, Akershus University Hospital, Norbyhagen, Norway.
FAU - Franssen, Eric
AU  - Franssen E
AD  - Department of Orthopedic Surgery, Stavanger University Hospital, Stavanger, 
      Norway.
FAU - Indrekvam, Kari
AU  - Indrekvam K
AD  - Kysthospitalet in Hagevik. Orthopedic Clinic, Haukeland University Hospital, 
      Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, 
      Norway.
FAU - Solberg, Tore
AU  - Solberg T
AD  - Neurosurgical Department, University Hospital of North Norway, Tromso, Norway.
FAU - Hermansen, Erland
AU  - Hermansen E
AD  - Department of Orthopedic Surgery, Alesund Hospital, More og Romsdal Hospital 
      Trust, Alesund, Norway; Department of Clinical Medicine, University of Bergen, 
      Bergen, Norway.
LA  - eng
PT  - Journal Article
DEP - 20240123
PL  - United States
TA  - Spine J
JT  - The spine journal : official journal of the North American Spine Society
JID - 101130732
SB  - IM
OTO - NOTNLM
OT  - Adjacent level stenosis
OT  - Decompression
OT  - Lumbar spinal stenosis
OT  - Multi-level spinal stenosis
OT  - Surgical treatment
COIS- Declaration of competing interest The authors declare that they have no known 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this paper.
EDAT- 2024/01/25 00:42
MHDA- 2024/01/25 00:42
CRDT- 2024/01/24 19:16
PHST- 2023/09/11 00:00 [received]
PHST- 2023/12/03 00:00 [revised]
PHST- 2024/01/16 00:00 [accepted]
PHST- 2024/01/25 00:42 [pubmed]
PHST- 2024/01/25 00:42 [medline]
PHST- 2024/01/24 19:16 [entrez]
AID - S1529-9430(24)00017-2 [pii]
AID - 10.1016/j.spinee.2024.01.010 [doi]
PST - aheadofprint
SO  - Spine J. 2024 Jan 23:S1529-9430(24)00017-2. doi: 10.1016/j.spinee.2024.01.010.