{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:32:20Z","timestamp":1786649540212,"version":"build-2736575974"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To compare the impact of upper versus lower lumbar decompression on patient-reported outcome measures (PROMs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>Patients undergoing L1\u2013L2, L2\u2013L3, L4\u2013L5, or L5\u2013S1 single-level elective decompression with 1-year PROMs were identified. Included PROMs were the Oswestry Disability Index (ODI), visual analog scale (VAS) back and leg, and Short Form-12 physical (PCS) and mental (MCS) component scores. Minimal clinically important differences (MCID) were calculated. Multivariable regressions assessed the independent predictive ability of operative level controlling for demographic confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Three hundred and forty-six patients were included (94 upper lumbar decompressions). Upper lumbar decompression patients were older (64.0 vs. 46.9,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), had higher body mass index (BMI) (31.4 vs. 28.4,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) and Charlson Comorbidity Index (CCI) (3.15 vs. 1.56,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), and more commonly had diabetes (19.5% vs. 7.69%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.017). These patients had similar 1-year scores in ODI, VAS leg, and MCS but performed worse at 1 year in VAS back (3.58 vs. 2.75,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.016) and at 6 months in ODI (24.5 vs. 17.9,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.005) and were less likely to achieve MCID in PCS (48.8% vs. 64.4%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.041). However, multivariable regression did not identify upper lumbar decompression as independently associated with 1-year VAS back scores, 6-month ODI scores, or MCID achievement in PCS after controlling for age, BMI, diabetes, and CCI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Patients undergoing upper lumbar decompression demonstrated worse PROMs. However, multivariable analyses suggested these differences were attributable to comorbidity burden and BMI, rather than operative level. This suggests that surgeons and patients can expect similar pain and function improvement from upper lumbar decompression when accounting for baseline patient characteristics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jcvjs.jcvjs_66_25","type":"journal-article","created":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T14:00:56Z","timestamp":1751551256000},"page":"218-223","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["The impact of operative level on patient-reported outcome measures following single-level posterior lumbar decompression for disc herniation"],"prefix":"10.4103","volume":"16","author":[{"given":"Jonathan","family":"Dalton","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert 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Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barrett I.","family":"Woods","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark F.","family":"Kurd","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian David","family":"Kaye","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose 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