No long-term benefit of decompression of borderline lumbar spinal stenosis level adjacent to more stenotic index level: study

Written By : Dr Supreeth D R Published On 2026-02-09T20:30:03+05:30 | Updated On 10 Feb 2026 11:13 AM IST

Lumbar spinal stenosis (LSS) frequently involves multiple levels of the spine. Whether to perform single-level decompression (SLD) or multi-level decompression (MLD) in patients with at least one borderline stenotic level adjacent to the primary (index) level, remains debated. Short-term follow-up studies show comparable outcomes for both strategies.

Erland Hermansen et al conducted a study to assess five-year outcomes in patients with adjacent borderline stenosis. The article has been published in ‘European Spine Journal.’

All participants were recruited from the NORDSTEN-SST. Patients with a preoperative adjacent borderline stenosis, defined as Schizas grade B or C, in addition to the index level, were included in the study. The cohort was divided into two groups based on the type of surgical intervention: SLD or MLD. Baseline characteristics and clinical outcomes were recorded for both groups, with follow-up conducted five years postoperatively. Subgroup analysis based on the Schizas grade in the adjacent level were also performed.

The key findings of the study were:

• Out of 437 patients in the NORDSTEN-SST, the 222 with borderline adjacent stenosis were included. Among these, 114 underwent SLD, while 108 underwent MLD.

• In the MLD group 100 patients were operated in two levels, and 8 patients underwent three level surgery.

• The Dural sac cross-sectional area (DSCA) in the index level was similar in the SLD group vs. the MLD group,

• Baseline characteristics were comparable between groups. Mean change in ODI-score was − 16.0 (95% CI -18.9—12.9) for the SLD group and − 18.6 (95% CI -22.1—15.1) for the MLD group, p = 0.26.

• Subgroup analyses revealed no significant differences between groups in clinical outcomes or need for subsequent spinal surgeries.

The authors concluded – “In this observational study, five-year clinical outcomes in patients operated for lumbar spinal stenosis with a significant stenotic index level were not influenced by additional decompression of preoperative adjacent borderline stenotic levels.”

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.