Does multilevel lumbar stenosis lead to poorer outcomes? A subanalysis of the Spine Patient Outcomes Research Trial (SPORT) lumbar stenosis study

Daniel K. Park, Howard S. An, Jon D. Lurie, Wenyan Zhao, Anna Tosteson, Tor D. Tosteson, Harry Herkowitz, Thomas Errico, James Neil Weinstein

Research output: Contribution to journalArticlepeer-review

57 Scopus citations


STUDY DESIGN. A subanalysis study. OBJECTIVE. The purpose of this study was to determine the impact of multilevel lumbar stenosis with or without degenerative spondylolisthesis compared to single level disease on patients' baseline symptoms and clinical outcomes over time. SUMMARY OF BACKGROUND DATA. Previous studies have demonstrated better clinical outcomes with surgery than nonoperative treatment in patients with spinal stenosis with or without degenerative spondylolisthesis. However, the impact of multilevel stenosis has not been studied in these patients. METHODS. The results from a multicenter randomized and observational study, the Spine Patient Outcomes Research Trial (SPORT) comparing surgical versus nonoperative treatment for spinal stenosis with or without spondylolisthesis, were analyzed. The primary outcomes measures were the Bodily Pain and Physical Function scales of the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and the modified Oswestry Disability Index at 6 weeks, 3 months, 6 months, 1 year, and 2 years. Secondary outcome measures included the stenosis bothersomeness index, leg pain bothersomeness, low back pain bothersomeness, and patient satisfaction. RESULTS. In this subanalysis of SPORT data, multilevel spinal stenosis did not demonstrate worse baseline symptoms or worse treatment outcomes in isolated spinal stenosis; however, if concomitant degenerative spondylolisthesis existed, patients with only single level stenosis tended to improve more than those with multilevel stenosis, particularly after surgery. CONCLUSION. Patients with spinal stenosis without associated degenerative spondylolisthesis or scoliosis can be managed nonoperatively irrespective of the number of levels involved. If surgery is performed, the number of levels treated does not predict outcome. In contrast, patients with concomitant degenerative spondylolisthesis and single level stenosis do better surgically than those with additional levels of stenosis. This study emphasizes the importance of shared decision-making between the physician and patient when considering treatment for spinal stenosis.

Original languageEnglish (US)
Pages (from-to)439-446
Number of pages8
Issue number4
StatePublished - Feb 2010


  • Clinical outcomes
  • Degenerative spondylolisthesis
  • Lumbar decompression
  • Spinal stenosis

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology


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