title: The Influence of Single-level Versus Multilevel Decompression on the Outcome in Multisegmental Lumbar Spinal Stenosis: Analysis of the Lumbar Spinal Outcome Study (LSOS) Data.
abstract: METHODS
  This is prospective multicenter cohort study.
  
  
  OBJECTIVE
  To assess whether patients with confirmed multisegmental lumbar spinal stenosis benefit more from a single-level or a multilevel decompression.
  
  
  BACKGROUND
  In multisegmental lumbar spinal stenotic cases, the decision as to how many levels of stenosis need to be operated to achieve the best possible clinical outcome is still unknown and remains a controversy between spine surgeons.
  
  
  METHODS
  Patients of the Swiss Lumbar Stenosis Outcome Study (LSOS) with confirmed multisegmental LSS undergoing first-time decompression without fusion were enrolled in this study. The main outcomes of this study were Spinal Stenosis Measure (SSM) symptoms and function over time, measured at baseline, 6, 12, and 24 months follow-up. Further outcomes of interest were changes in SSM, numeric rating scale, feeling thermometer, the EQ-5D-EL, and the Roland and Morris disability questionnaire from baseline to 6, 12, and 24 months.
  
  
  RESULTS
  After 12 months, a total of 141 patients met the inclusion criteria; of these, 33 (23%) underwent a single-level and 108 (77%) a multilevel decompression. Multilevel decompression was associated with a significantly less favorable SSM symptoms and function score, respectively, as compared with single-level decompression. In all further outcomes of interest single-level as well as multilevel patients improved over time.
  
  
  CONCLUSIONS
  Our study showed that in multisegmental stenotic cases a single-level decompression was associated with a significantly more favorable SSM symptoms and function score, respectively, as compared with multilevel decompression. This study provides evidence that in multisegmental stenotic cases a single-level decompression might be sufficient to improve patient's symptoms and function.
authors.affiliation: Department of Orthopedics and Neurosurgery, Spine Center, Schulthess Clinic.
authors.forename: Nils H
authors.initials: NH
authors.lastname: Ulrich
authors.affiliation: Horten Centre for Patient Oriented Research and Knowledge Transfer.
authors.forename: Jakob M
authors.initials: JM
authors.lastname: Burgstaller
authors.affiliation: Horten Centre for Patient Oriented Research and Knowledge Transfer.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Held
authors.affiliation: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Winklhofer
authors.affiliation: Spine Division, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Mazda
authors.initials: M
authors.lastname: Farshad
authors.affiliation: Horten Centre for Patient Oriented Research and Knowledge Transfer.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pichierri
authors.affiliation: Horten Centre for Patient Oriented Research and Knowledge Transfer.
authors.forename: Johann
authors.initials: J
authors.lastname: Steurer
authors.affiliation: Department of Orthopedics and Neurosurgery, Spine Center, Schulthess Clinic.
authors.forename: François
authors.initials: F
authors.lastname: Porchet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications; D011788:Quality of Life; D012720:Severity of Illness Index; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000523:psychology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome