STUDY DESIGN: A subanalysis study. OBJECTIVE: The purpose of this study was to determine the impact of multilevel lumbar stenosis with or without degenerative spondylolisthesis compared to single level disease on patients' baseline symptoms and clinical outcomes over time. SUMMARY OF BACKGROUND DATA: Previous studies have demonstrated better clinical outcomes with surgery than nonoperative treatment in patients with spinal stenosis with or without degenerative spondylolisthesis. However, the impact of multilevel stenosis has not been studied in these patients. METHODS: The results from a multicenter randomized and observational study, the Spine Patient Outcomes Research Trial (SPORT) comparing surgical versus nonoperative treatment for spinal stenosis with or without spondylolisthesis, were analyzed. The primary outcomes measures were the Bodily Pain and Physical Function scales of the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and the modified Oswestry Disability Index at 6 weeks, 3 months, 6 months, 1 year, and 2 years. Secondary outcome measures included the stenosis bothersomeness index, leg pain bothersomeness, low back pain bothersomeness, and patient satisfaction. RESULTS: In this subanalysis of SPORT data, multilevel spinal stenosis did not demonstrate worse baseline symptoms or worse treatment outcomes in isolated spinal stenosis; however, if concomitant degenerative spondylolisthesis existed, patients with only single level stenosis tended to improve more than those with multilevel stenosis, particularly after surgery. CONCLUSION:Patients with spinal stenosis without associated degenerative spondylolisthesis or scoliosis can be managed nonoperatively irrespective of the number of levels involved. If surgery is performed, the number of levels treated does not predict outcome. In contrast, patients with concomitant degenerative spondylolisthesis and single level stenosis do better surgically than those with additional levels of stenosis. This study emphasizes the importance of shared decision-making between the physician and patient when considering treatment for spinal stenosis.
RCT Entities:
STUDY DESIGN: A subanalysis study. OBJECTIVE: The purpose of this study was to determine the impact of multilevel lumbar stenosis with or without degenerative spondylolisthesis compared to single level disease on patients' baseline symptoms and clinical outcomes over time. SUMMARY OF BACKGROUND DATA: Previous studies have demonstrated better clinical outcomes with surgery than nonoperative treatment in patients with spinal stenosis with or without degenerative spondylolisthesis. However, the impact of multilevel stenosis has not been studied in these patients. METHODS: The results from a multicenter randomized and observational study, the Spine Patient Outcomes Research Trial (SPORT) comparing surgical versus nonoperative treatment for spinal stenosis with or without spondylolisthesis, were analyzed. The primary outcomes measures were the Bodily Pain and Physical Function scales of the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and the modified Oswestry Disability Index at 6 weeks, 3 months, 6 months, 1 year, and 2 years. Secondary outcome measures included the stenosis bothersomeness index, leg pain bothersomeness, low back pain bothersomeness, and patient satisfaction. RESULTS: In this subanalysis of SPORT data, multilevel spinal stenosis did not demonstrate worse baseline symptoms or worse treatment outcomes in isolated spinal stenosis; however, if concomitant degenerative spondylolisthesis existed, patients with only single level stenosis tended to improve more than those with multilevel stenosis, particularly after surgery. CONCLUSION:Patients with spinal stenosis without associated degenerative spondylolisthesis or scoliosis can be managed nonoperatively irrespective of the number of levels involved. If surgery is performed, the number of levels treated does not predict outcome. In contrast, patients with concomitant degenerative spondylolisthesis and single level stenosis do better surgically than those with additional levels of stenosis. This study emphasizes the importance of shared decision-making between the physician and patient when considering treatment for spinal stenosis.
Authors: James N Weinstein; Tor D Tosteson; Jon D Lurie; Anna N A Tosteson; Emily Blood; Brett Hanscom; Harry Herkowitz; Frank Cammisa; Todd Albert; Scott D Boden; Alan Hilibrand; Harley Goldberg; Sigurd Berven; Howard An Journal: N Engl J Med Date: 2008-02-21 Impact factor: 91.245
Authors: Yasutsugu Yukawa; Lawrence G Lenke; Janet Tenhula; Keith H Bridwell; K Daniel Riew; Kathy Blanke Journal: J Bone Joint Surg Am Date: 2002-11 Impact factor: 5.284
Authors: Yvonne Yan On Lau; Ryan Ka Lok Lee; James Francis Griffith; Carol Lai Yee Chan; Sheung Wai Law; Kin On Kwok Journal: Eur Spine J Date: 2017-07-12 Impact factor: 3.134
Authors: Yossi Smorgick; Daniel K Park; Kevin C Baker; Jon D Lurie; Tor D Tosteson; Wenyan Zhao; Harry N Herkowitz; Jeffrey S Fischgrund; James N Weinstein Journal: Spine (Phila Pa 1976) Date: 2013-05-01 Impact factor: 3.468
Authors: Adam Pearson; Jon Lurie; Tor Tosteson; Wenyan Zhao; William Abdu; James N Weinstein Journal: Spine (Phila Pa 1976) Date: 2012-10-01 Impact factor: 3.468
Authors: Michael T Nolte; Philip K Louie; Bryce A Basques; Arya G Varthi; Justin C Paul; Krishn Khanna; Tarush Khurana; Arshan Chaudhri; Dino Samartzis; Edward J Goldberg; Howard S An Journal: Int J Spine Surg Date: 2021-09-22
Authors: Adam Pearson; Emily Blood; Jon Lurie; Tor Tosteson; William A Abdu; Alan Hillibrand; Keith Bridwell; James Weinstein Journal: Spine (Phila Pa 1976) Date: 2010-02-01 Impact factor: 3.468
Authors: Adam M Pearson; Jon D Lurie; Tor D Tosteson; Wenyan Zhao; William A Abdu; James N Weinstein Journal: Spine (Phila Pa 1976) Date: 2013-10-01 Impact factor: 3.468
Authors: Sheng Xu; Ming Han Lincoln Liow; Keng Meng Jeremy Goh; William Yeo; Zhixing Marcus Ling; Chee Cheong Reuben Soh; Seang Beng Tan; Li Tat John Chen; Chang Ming Guo Journal: Int J Spine Surg Date: 2019-10-31