Subramanian Tejas, Owusu Sarpong Stephane, Hirase Takashi, Oquendo Yousi, Dekhne Mihir, Asada Tomoyuki, Harhash Tarek, Zhao Eric R, Ehrlich Adin, Durbas Atahan, Araghi Kasra, Kaidi Austin C, Kazarian Gregory S, Musharbash Farah, Colon Luis Felipe, Shahi Pratyush, Morse Kyle, Cunningham Matthew E, Dowdell James, Lovecchio Francis C, Kim Han Jo, Qureshi Sheeraz, Iyer Sravisht
Hospital for Special Surgery, New York, NY, USA.
Weill Cornell Medical College, New York, NY, USA.
Global Spine J. 2025 Aug 28:21925682251370264. doi: 10.1177/21925682251370264.
Study DesignRetrospective cohort study.ObjectiveIn patients with multilevel degenerative lumbar pathology, the decision to extend fusion across all decompressed levels remains a subject of debate. While fusion provides stability in cases of instability or deformity, its necessity for adjacent levels without specific fusion indications is unclear. This study evaluates whether decompression alone at levels without clear fusion indications can achieve similar outcomes compared to spanning the entire decompression with fusion.MethodsThe present study is a retrospective cohort study. Patients who underwent one-level decompression and fusion with 2 level decompression (SLF) were propensity score matched with patients who underwent two-level decompression and fusion (DLF) for degenerative conditions of the lumbar spine. Patient-reported outcome measures (PROMs), complication rates, revision surgeries, and recovery kinetics were compared between the cohorts.ResultsAfter propensity score matching a total of 43 SLF patients were compared with 43 DLF patients. Early follow-up (<6 months) showed significantly higher SF-12 PCS scores in the SLF group ( = .042) and greater achievement of VAS-leg MCID (88.9% vs 59.4%, = .012). Long-term outcomes (≥6 months) demonstrated no significant differences in ODI, VAS-back, VAS-leg, or SF-12 PCS scores between groups. There were no differences in intraoperative or perioperative complications. The postoperative complication rate was significantly higher in the DLF group (25.6% vs 7%, = .019) including 4 DLF patients that underwent revision surgery while no SLF patients required revision during their follow up time.ConclusionSLF resulted in similar long-term outcomes compared to DLF with fewer revisions and adjacent segment symptoms. These findings suggest that "saving" a fusion level in cases without a specific fusion indication at the adjacent level may be warranted to optimize longevity of the construct. Further research is necessary to refine patient selection for fusion levels in degenerative lumbar disease.
研究设计
回顾性队列研究。
目的
在患有多节段退行性腰椎病变的患者中，决定跨越所有减压节段进行融合仍然存在争议。虽然融合在不稳定或畸形病例中提供稳定性，但其对无特定融合指征的相邻节段的必要性尚不清楚。本研究评估在无明确融合指征的节段单独进行减压与融合整个减压节段相比是否能取得相似的结果。
方法
本研究为回顾性队列研究。对因腰椎退行性疾病接受单节段减压融合加双节段减压（SLF）的患者与接受双节段减压融合（DLF）的患者进行倾向评分匹配。比较两组患者的患者报告结局指标（PROMs）、并发症发生率、翻修手术情况和恢复动力学。
结果
经过倾向评分匹配后，共43例SLF患者与43例DLF患者进行比较。早期随访（<6个月）显示SLF组的SF - 12身体成分评分显著更高（P = 0.042），且VAS腿部最小临床重要差异的达成率更高（88.9%对59.4%，P = 0.012）。长期结局（≥6个月）表明两组在ODI、VAS背部、VAS腿部或SF - 12身体成分评分方面无显著差异。术中或围手术期并发症无差异。DLF组术后并发症发生率显著更高（25.6%对7%，P = 0.019），其中4例DLF患者接受了翻修手术，而SLF组在随访期间无患者需要翻修。
结论
与DLF相比，SLF产生了相似的长期结局，翻修和相邻节段症状更少。这些发现表明，在相邻节段无特定融合指征的情况下“保留”一个融合节段可能有助于优化植入物的使用寿命。有必要进行进一步研究以完善退行性腰椎疾病融合节段的患者选择。
