Single and multilevel decompression alone in patients with multilevel lumbar spinal stenosis: a systematic review and meta-analysis

Multilevel lumbar spinal stenosis (LSS) is a prevalent degenerative condition characterized by lower back pain, intermittent claudication, and radicular leg pain. It ranks as one of the primary indications of spinal surgery in patients aged 65 and older. In this study, we aim to compare single-level and multilevel approaches for decompression alone in LSS considering the incidence of complications, reduction in pain score, and rates of surgical revisions. A systematic search was conducted on PubMed (MEDLINE), Embase, Web of Science, and Cochrane Library databases for studies directly comparing single-level and multilevel decompression in patients with LSS. A total of 1,039 patients across five studies were analyzed, with 605 (58.2%) patients who underwent single-level decompression and 434 (41.8%) patients in the multilevel decompression cohort. Despite the multilevel decompression group showing a higher incidence of complications (14% vs. 7%), there was no statistically significant difference between groups (OR 0.60; 95%CI 0.34-1.08; p = 0.087; I2 = 0%). Also, there was no statistically significant difference between the groups in terms of pain score reduction. (OR 0.70; 95%CI -0.37-1.77; p = 0.199; I2 = 96%). Ultimately, surgical revision was necessary for 33 (8%) patients in the single-level cohort and 7 (5%) patients in the multilevel group, however, there was no statistically significant difference (OR 1.81; 95% CI 0.78-4.18; p = 0.166; I2 = 0%). Decompression involving two or more levels showed comparable postoperative outcomes to single-level decompression, suggesting it could be a non-inferior procedure. Nevertheless, further research is required to solidify its efficacy and safety profile.