title: Long-term outcomes of long level posterolateral fusion in lumbar degenerative disease: comparison of long level fusion versus short level fusion: a case control study.
abstract: BACKGROUND
  We sought to evaluate the long-term outcomes of long-level instrumented posterolateral fusion (PLF) directly compared to those with short level instrumented PLF for degenerative spinal stenosis.
  
  
  METHODS
  From 1987-2002, patients who underwent instrumented PLF with wide decompression for degenerative spinal stenosis were reviewed. A total of 295 patients were available for follow-up over 10 years (mean, 14 years). These patients were divided into Group 1 (fusion of 1 or 2 levels) and Group 2 (fusion of three or more levels). Clinical and radiological outcomes were evaluated.
  
  
  RESULTS
  On clinical outcomes, Group 1 showed better results than Group 2 based on the Katz's Activities Daily Living index (p = 0.024), Kirkaldy-Willis criteria (p = 0.001) and the Korean version of the Oswestry disability index (p = 0.01). However, excellent and good outcome was noted in more than 64.5 % in Group 2. For radiological outcomes, overall fusion rate was higher in Group 1 compared with Group 2, but not significantly different (p = 0.35). However, the metal problems and surgical complications were more developed in Group 2 (p < 0.001). Although the radiologic changes on adjacent segments increased in accordance with the follow-up period, particularly in Group 2 (p < 0.001), no correlation with clinical symptoms was found.
  
  
  CONCLUSIONS
  The long-level fusion group maintained acceptable clinical and radiological outcomes compared to the short-level fusion group at minimum of 10 years of follow-up.
authors.affiliation: Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, South Korea. gaia-silver@hanmail.net.
authors.forename: Jin Kyu
authors.initials: JK
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, South Korea. mad_about@hanmail.net.
authors.forename: Chul Woong
authors.initials: CW
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, South Korea. cnkang65@hanyang.ac.kr.
authors.forename: Chang-Nam
authors.initials: CN
authors.lastname: Kang
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D001863:Bone Screws; D019299:Decompression, Surgical; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013130:Spinal Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome