Comparative analysis of lumbar spinal decompression: Propensity-matched evaluation of multilevel vs. single-level decompression for spinal stenosis.

Introduction: Lumbar spinal stenosis results in pain in the buttocks and/or legs due to reduced space in the spinal canal. MRI findings indicate that approximately 40 % of clinically diagnosed patients have multilevel stenosis. For patients with severe symptoms requiring spinal decompression, surgeons must decide the optimal number of levels to decompress. However, the benefits of operating on multiple stenotic levels remain uncertain, as limited research has explored this issue. Research question: Do patients with multi-level lumbar stenosis experience less benefit from spinal decompression at the stenotic levels compared to patients with single-level lumbar stenosis? Material and methods: In this study, all patients who underwent spinal decompression due to spinal stenosis between June 2010 and December 2024 were included. Pre- and postoperative data collected included demographic information, back and leg pain levels, health-related quality of life, disability, and the duration of back and leg pain before surgery. Patients were categorized into four groups based on the number of decompressed levels. To ensure comparability between the groups, propensity-score matching was conducted in a 1:1 ratio. Results: Of 3307 patients undergoing spinal decompression, we formed four matched cohorts, balanced on preoperative factors. With the exception of a significant increasing number of dural tears proportional to the number of decompressed levels, there were no differences in complication rates or patient-reported satisfaction with the outcome. Discussion and conclusion: We found no significant difference in patient satisfaction and health-related quality of life in patients related to the number of levels decompressed due to symptomatic spinal stenosis.