Introduction: Lumbar spinal stenosis (LSS) is a common degenerative spinal condition. In cases of multilevel LSS, the optimal number of levels to decompress for the best clinical outcome is still uncertain and remains a controversy among spine surgeons. This meta-analysis aimed to assess whether patients with multilevel LSS benefit more from single-level or multilevel decompression.
Methods: Following PRISMA guidelines, PubMed, Embase, Cochrane Library, and Web of Science were systematically searched for studies comparing the outcomes of single-level versus multilevel decompression for multisegmental LSS. The outcomes assessed included Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), EuroQol 5-dimensional questionnaire (EQ-5D), infection, dural tear, and perioperative complications. Meta-analysis was performed using a random-effects model.
Results: Three studies were included, comprising 475 patients, of whom 195 (41%) underwent single-level and 280 (59%) received multilevel decompression surgery. When compared to multilevel decompression, single-level decompression demonstrated an improvement in ODI (MD -10.57; [95% CI -20.31, -0.83]; p=0.03; I²=97%). VAS scores (MD - 0.76; [95% CI -1.77, 0.26]; p=0.14; I²=89%) and EQ-5D (MD 0.61; [95% CI -0.18, 1.39]; p=0.13; I²=89%) did not show statistically significant differences. Dural tear incidence (RR 1.39; [95% CI 0.40, 4.80]; p=0.59; I²=0%), infection rates (RR 0.47; [95% CI 0.10, 2.13]; p=0.32; I²=0%), and perioperative complications (RR 0.73; [95% CI 0.45, 1.19]; p=0.21; I²=0%) did not differ significantly between groups.
Conclusion : In this meta-analysis, multilevel decompression showed no superior clinical effectiveness compared with single-level surgery in patients with multisegmental LSS. This finding indicates that, in cases of multilevel stenosis, a single-level surgery might be sufficient to improve a patient's functional outcome.
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