Comparison of clinical outcomes between selective fusion and dual-segment fusion in endoscopic surgery for Bi-segmental lumbar spinal stenosis with segmental instability.

Abstract

ObjectiveTo investigate the clinical efficacy of selective versus dual-segment fusion in the treatment of bi-segmental lumbar spinal stenosis with segmental instability using spinal endoscopy.MethodsA retrospective analysis was conducted on 49 patients with bi-segmental degenerative lumbar disease who underwent endoscopic spinal surgery at our institution between October 2022 and June 2025. In the selective fusion group (n = 27), fusion was performed on the unstable segment and decompression was performed on the other segment. Both segments underwent fusion in the dual-segment fusion group (n = 22). Surgical time, intraoperative blood loss, hospital stay, Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) fusion rate, and functional improvement were compared.ResultsThe selective fusion group had a significantly shorter operative time and lesser blood loss than the dual-fusion group (<i>p</i> < 0.05). Postoperative hospital stay did not differ significantly between groups. Both groups demonstrated significant postoperative improvements in VAS and ODI scores (<i>p</i> < 0.001), with no intergroup differences. At 12 months, Bridwell Grade I-II fusion rates were comparable between the two groups (93.3% vs 90.9%, <i>p</i> > 0.05). The fusion rates and functional outcomes were comparable.ConclusionIn patients with bi-segmental lumbar stenosis and single-segment instability, Selective fusion under endoscopic guidance provides comparable clinical and radiological outcomes to dual-segment fusion, with reduced operative trauma and faster recovery. This minimally invasive strategy effectively balances surgical stability with functional preservation and warrants broader clinical application.