Does multilevel lumbar stenosis lead to poorer outcomes?: a subanalysis of the Spine Patient Outcomes Research Trial (SPORT) lumbar stenosis study.
METHODS
A subanalysis study.


OBJECTIVE
The purpose of this study was to determine the impact of multilevel lumbar stenosis with or without degenerative spondylolisthesis compared to single level disease on patients' baseline symptoms and clinical outcomes over time.


BACKGROUND
Previous studies have demonstrated better clinical outcomes with surgery than nonoperative treatment in patients with spinal stenosis with or without degenerative spondylolisthesis. However, the impact of multilevel stenosis has not been studied in these patients.


METHODS
The results from a multicenter randomized and observational study, the Spine Patient Outcomes Research Trial (SPORT) comparing surgical versus nonoperative treatment for spinal stenosis with or without spondylolisthesis, were analyzed. The primary outcomes measures were the Bodily Pain and Physical Function scales of the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and the modified Oswestry Disability Index at 6 weeks, 3 months, 6 months, 1 year, and 2 years. Secondary outcome measures included the stenosis bothersomeness index, leg pain bothersomeness, low back pain bothersomeness, and patient satisfaction.


RESULTS
In this subanalysis of SPORT data, multilevel spinal stenosis did not demonstrate worse baseline symptoms or worse treatment outcomes in isolated spinal stenosis; however, if concomitant degenerative spondylolisthesis existed, patients with only single level stenosis tended to improve more than those with multilevel stenosis, particularly after surgery.


CONCLUSIONS
Patients with spinal stenosis without associated degenerative spondylolisthesis or scoliosis can be managed nonoperatively irrespective of the number of levels involved. If surgery is performed, the number of levels treated does not predict outcome. In contrast, patients with concomitant degenerative spondylolisthesis and single level stenosis do better surgically than those with additional levels of stenosis. This study emphasizes the importance of shared decision-making between the physician and patient when considering treatment for spinal stenosis.
Park
Daniel K
DK
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
An
Howard S
HS
Lurie
Jon D
JD
Zhao
Wenyan
W
Tosteson
Anna
A
Tosteson
Tor D
TD
Herkowitz
Harry
H
Errico
Thomas
T
Weinstein
James N
JN
D000368:Aged; D001416:Back Pain / Q000209:etiology / Q000601:surgery / Q000628:therapy; D019299:Decompression, Surgical; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects; D010147:Pain Measurement; D017060:Patient Satisfaction; D018579:Patient Selection; D020127:Recovery of Function; D012720:Severity of Illness Index; D013130:Spinal Stenosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D013168:Spondylolisthesis / Q000150:complications / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States