One-Level or Multilevel Interbody Fusion for Multilevel Lumbar Degenerative Diseases: A Prospective Randomized Control Study with a 4-Year Follow-Up.

Abstract

The treatment of multilevel lumbar degenerative disease (LDD) is complicated and challenging, and the optimal surgical strategy remains controversial. To compare the differences in clinical and radiologic outcomes and in complications after 1-level interbody fusion versus multilevel interbody fusion for the treatment of multilevel LDD. A total of 100 patients with multilevel LDD were randomized in a 1:1 ratio into the 1-level interbody fusion group or the multilevel interbody fusion group. Clinical and radiologic results and major complications in the 2 groups were analyzed. Clinical outcomes were assessed using the Visual Analog Scale for radicular and back pain, the Oswestry Disability Index, and the short-form 36 physical score. Clinical status was assessed by the Whitecloud classification. Radiologic evaluation included assessment of lumbar lordosis, pelvic incidence, and sacral slope. There were no significant differences in clinical and radiologic results between the 2 groups. Procedure duration and intraoperative blood loss were significantly greater in the multilevel interbody fusion group than in the 1-level interbody fusion group; the multilevel interbody fusion group also had greater incidences of temporary nerve root palsy, wound infection, and adjacent segment disease. A hybrid technique including 1-level interbody fusion and multilevel posterolateral fusion is recommended for patients with multilevel LDD.