PT  - JOURNAL ARTICLE
AU  - Khanna, Ryan
AU  - Malone, Hani
AU  - Keppetipola, Kavantissa M.
AU  - Deutsch, Harel
AU  - Fessler, Richard G.
AU  - Fontes, Ricardo B.
AU  - O'Toole, John E.
TI  - Multilevel Minimally Invasive Lumbar Decompression: Clinical Efficacy and Durability to 2 Years
AID  - 10.14444/8102
DP  - 2021 Aug 01
TA  - International Journal of Spine Surgery
PG  - 795--802
VI  - 15
IP  - 4
4099  - https://www.ijssurgery.com/content/15/4/795.short
4100  - https://www.ijssurgery.com/content/15/4/795.full
SO  - Int J Spine Surg2021 Aug 01; 15
AB  - Background: The clinical efficacy of single-level minimally invasive lumbar decompression and/or microdiscectomy is well established, with improved postoperative functional outcome and pain scores. However, there is a paucity of clinical data supporting the use of minimally invasive (MIS) techniques in a single operation to address pathology at multiple lumbar levels, and this study attempts to address this issue.Methods: A retrospective review of prospectively collected data from patients with symptomatic lumbar stenosis and/or disc herniations who underwent multilevel minimally invasive decompression or microdiscectomy from November 2014 to February 2018 was conducted at a single academic medical center. Patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI), visual analog scale (VAS) for back and leg pain, 12-Item Short Form Health Survey (SF-12) Physical Component Summary Score (PCS) and Mental Component Summary Score (MCS), and Scoliosis Research Society survey (SRS-30), were prospectively collected before surgery and at 3 months, 6 months, 1 year, and 2 years postoperatively.Results: During the study period, 92 patients received multilevel (≥2 level) MIS lumbar decompression and/or discectomy (69 two level, 21 three level, 2 four level). The mean age at surgery was 69.7 years, and 23 (25%) patients were women. Patient-reported outcomes were significantly improved both in the short and long term except for the SF-12 MCS. Average improvement from baseline was (at 3 months and 2 years, respectively): VAS back, −3.9 and −2.8; VAS leg, −3.6 and −2.6; ODI, −13 and −14.6; SF-12 MCS, 2.8 and −0.3; SF-12 PCS, 6.9 and 10.1; and SRS-30, 0.57 and 0.55. Minimal clinically important difference for the study population was reached for every PROM except SF-12 MCS. Surgical complications occurred in 16 patients (17.4%), and 8 patients (8.6%) required postoperative fusions within 2 years.Conclusion: The use of MIS techniques to perform lumbar decompression and/or discectomy at multiple levels was found to be both clinically effective and durable. Fusion rates remained low 2 years after the index surgery and were consistent with literature data for open procedures.Level of Evidence: 2.