Equivalent Patient-Reported Clinical Outcomes Between Single-Level and Multilevel Biportal Endoscopic Decompression at 5-Year Follow-up.

STUDY

DESIGN

Retrospective.

OBJECTIVE

To compare long term clinical outcomes of single-level versus multilevel decompression using unilateral biportal endoscopic (UBE) decompression for degenerative lumbar spinal stenosis without instability.

SUMMARY OF BACKGROUND DATA: Unilateral biportal endoscopic decompression has been shown to be effective in alleviating spinal stenosis without instability. Long-term data are lacking, and, in particular, a comparison between single-level and multilevel surgery using this minimally invasive technique has not been presented.

METHODS

Ninety-eight patients in each group were propensity matched based on demographics. All patients had at least 5-year follow-up. Clinical outcomes, including Oswestry Disability Index, visual analog system (VAS), time to ambulation, surgical time, and length of hospital stay, were investigated.

RESULT: Oswestry Disability Index improved from 62.98 ± 11.53 before surgery to 18.51 ± 8.63 at the final follow-up in single-level decompression (P < 0.001). Multilevel decompression demonstrated improvement from 64.66 ± 13.71 to 19.31 ± 9.42 (P < 0.001). Similarly, leg and back VAS decreased from 7.39 ± 0.91 and 6.11 ± 1.21 before surgery to 1.72 ± 0.548 and 1.82 ± 0.67 at the last follow-up (P < 0.001) for single-level decompression. In comparison, for the multilevel, leg and back VAS improved from 7.47 ± 1.09 and 6.29 ± 1.28 to 1.86 ± 0.58 and 1.91 ± 0.75 (P < 0.001). No difference was observed between the groups at any time point. Complications and revision rates did not differ. Time to ambulation and length stay was markedly longer in multilevel.

CONCLUSION

Outcomes, complication, and revision rates do not differ between single level and multilevel. UBE decompression can be applied to multiple levels without compromising outcomes if multiple-level decompression is deemed necessary.