Selected Fusion Combined With Adjacent Level Decompression In The Treatment Of Multilevel Lumar Stenosis

Object: To investigate the incidence of adjacent-segement degeneration(ASD) in lumbar stenosis patients who had undergone multilevel decompression combined with selected fusion, assess whether multilevel decompression combined with selected fusion is an acceptable surgical approach.Method: Radiographic ASD is defined by development of more than 4 mm of spondylolisthesis, more than 10 degrees of angular motion between adjacent vertebral bodies on flexion and extension radiographs, spinal stenosis caused by facet joint hypertrophy, degenerative scoliosis, more than 10% loss of disc height, and more than 3 mm of osteophyte formation.115 lumbar stenosis patients treated by multilevel decompression combined with selected fusion underwent follow-up for 2 years(mean 26±5.5months). In the radiological measurement, disc height, osteophyte, ROM of the level decompressed without fusion were estimated. The clinical result was evaluated by Oswestry Disability Index(ODI) and visual analog scale(VAS) at preoperation, immediate postoperation, at one year and two years postoperation.Result: Both VAS and ODI had been improved progressively after surgery. No spondylolisthesis, spinal stenosis at the level decompressed without fusion had been found preoperation and postoperation.Disc height maintained well postoperation,Increasing ROM were not found after surgery, on the contrary, ROM decreased.Conclusion: ASD rarely occurs in patients who had undergone multilevel decompression with selected fusion, multilevel decompression with selected fusion is a good surgical approach for patients with multilevel lumbar stenosis.