One Versus Three-Level Fusion in Patients Undergoing Multilevel Lumbar Decompression : Relative Perioperative Risks and Five-Year Revisions.

Abstract

Study design: Retrospective cohort study.

Objective: To assess relative odds of perioperative complications, readmissions, and 5-year survival to reoperation for patients undergoing 3-level lumbar decompression who undergo 3-level fusion relative to 1-level fusion.

Background: Patients undergoing multilevel lumbar decompression may be indicated for fusion at one or more levels. The question of fusing only one level with indications such as spondylolisthesis or fusing all levels decompressed is of clinical interest in both the short and longer term.

Patients and methods: Patients undergoing 3-level lumbar decompression were extracted from the PearlDiver M165Orto database. The subset of these patients undergoing concomitant 3-level and 1-level lumbar fusion were identified and matched 1:1 based on patient age, sex, and Elixhauser Comorbidity Index scores. The incidence and odds of 90-day postoperative adverse events were compared between the two groups by multivariable analysis, and a comparative 5-year survival to lumbar spinal reoperation was determined.

Results: After matching, 28,276 patients were identified as undergoing 3-level lumbar decompression with 3-level fusion and the same for those undergoing 3-level decompression with 1-level fusion. Controlling for patient age, sex, and Elixhauser Comorbidity Index, patients undergoing 3-level fusion had significantly greater odds ratio (OR) of many 90-day adverse events and aggregated any (OR: 1.42), serious (OR: 1.44), and minor (OR: 1.42) adverse events, as well as readmissions (OR: 1.51; P < 0.0001 for all). Five-year survival to reoperation was significantly lower for those undergoing 3-level decompression with 3-level fusion ( P < 0.0001).

Conclusions: Patients undergoing 3-level lumbar decompression who underwent 3-level fusion were found to be at significantly greater odds of 90-day postoperative adverse events, readmissions, and 5-year reoperations relative to those undergoing 1-level fusion. The current data support the concept of limiting fusion to the levels with specific indications in the setting of multilevel lumbar decompressions and not needing to match the decompression and fusion levels.