title: Single- versus multilevel fusion for single-level degenerative spondylolisthesis and multilevel lumbar stenosis: four-year results of the spine patient outcomes research trial.
abstract: METHODS
  A subanalysis study.
  
  
  OBJECTIVE
  To compare surgical outcomes and complications of multilevel decompression and single-level fusion with multilevel decompression and multilevel fusion for patients with multilevel lumbar stenosis and single-level degenerative spondylolisthesis (DS).
  
  
  BACKGROUND
  In patients with DS who are treated surgically, decompression and fusion provide a better clinical outcome than decompression alone. Surgical treatment for multilevel lumbar stenosis and DS typically includes decompression and fusion of the spondylolisthesis segment and decompression with or without fusion for the other stenotic segments. To date, no study has compared the results of these 2 surgical options for single-level DS with multilevel stenosis.
  
  
  METHODS
  The results from a multicenter randomized and observational study, the Spine Patient Outcomes Research Trial comparing multilevel decompression and single-level fusion and multilevel decompression and multilevel fusion for spinal stenosis with spondylolisthesis, were analyzed. The primary outcome 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 1, 2, 3, and 4 years postoperatively. Secondary analysis consisted of stenosis bothersomeness index, low back pain bothersomeness, leg pain, patient satisfaction, and self-rated progress.
  
  
  RESULTS
  Overall, 207 patients were enrolled for the study, 130 had multlilevel decompression with 1 level fusion and 77 patients had multilevel decompression and multilevel fusion. For all primary and secondary outcome measures, there were no statistically significant differences in surgical outcomes between the 2 surgical techniques. However, operative time and intraoperative blood loss were significantly higher in the multilevel fusion group.
  
  
  CONCLUSIONS
  Decompression and single-level fusion and decompression and multilevel fusion provide similar outcomes in patients with multilevel lumbar stenosis and single-level DS.
authors.affiliation: Department of Orthopedic Surgery, William Beaumont Hospital, Royal Oak, MI 48073, USA. Noam_Yossi@yahoo.com
authors.forename: Yossi
authors.initials: Y
authors.lastname: Smorgick
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Park
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Baker
authors.forename: Jon D
authors.initials: JD
authors.lastname: Lurie
authors.forename: Tor D
authors.initials: TD
authors.lastname: Tosteson
authors.forename: Wenyan
authors.initials: W
authors.lastname: Zhao
authors.forename: Harry N
authors.initials: HN
authors.lastname: Herkowitz
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Fischgrund
authors.forename: James N
authors.initials: JN
authors.lastname: Weinstein
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011788:Quality of Life; D013123:Spinal Fusion / Q000379:methods*; D013130:Spinal Stenosis / Q000601:surgery*; D013168:Spondylolisthesis / Q000601:surgery*; D011795:Surveys and Questionnaires