Dalton Jonathan, Oris Robert J, Tarawneh Omar H, Toci Gregory R, Narayanan Rajkishen, Finan Dominic, Bash Hannah, Goldberg Marco, Mangan John J, Woods Barrett I, Kurd Mark F, Kaye Ian David, Canseco Jose A, Hilibrand Alan S, Vaccaro Alexander R, Schroeder Gregory D, Kepler Christopher K
Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
J Craniovertebr Junction Spine. 2025 Apr-Jun;16(2):218-223. doi: 10.4103/jcvjs.jcvjs_66_25. Epub 2025 Jul 3.
To compare the impact of upper versus lower lumbar decompression on patient-reported outcome measures (PROMs).
Patients undergoing L1-L2, L2-L3, L4-L5, or L5-S1 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.
Three hundred and forty-six patients were included (94 upper lumbar decompressions). Upper lumbar decompression patients were older (64.0 vs. 46.9, < 0.001), had higher body mass index (BMI) (31.4 vs. 28.4, < 0.001) and Charlson Comorbidity Index (CCI) (3.15 vs. 1.56, < 0.001), and more commonly had diabetes (19.5% vs. 7.69%, = 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, = 0.016) and at 6 months in ODI (24.5 vs. 17.9, = 0.005) and were less likely to achieve MCID in PCS (48.8% vs. 64.4%, = 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.
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.
比较上腰椎减压与下腰椎减压对患者报告结局指标（PROMs）的影响。
纳入接受L1-L2、L2-L3、L4-L5或L5-S1单节段择期减压且有1年PROMs数据的患者。纳入的PROMs指标包括奥斯威斯利功能障碍指数（ODI）、视觉模拟量表（VAS）背部和腿部评分，以及简明健康调查量表12项身体（PCS）和精神（MCS）成分得分。计算最小临床重要差异（MCID）。多变量回归分析评估手术节段在控制人口统计学混杂因素后的独立预测能力。
共纳入346例患者（94例接受上腰椎减压）。接受上腰椎减压的患者年龄更大（64.0岁对46.9岁，P<0.001），体重指数（BMI）更高（31.4对28.4，P<0.001），查尔森合并症指数（CCI）更高（3.15对1.56，P<0.001），且糖尿病患病率更高（19.5%对7.69%，P=0.017）。这些患者在ODI、VAS腿部评分和MCS方面的1年得分相似，但在VAS背部评分方面1年时表现更差（3.58对2.75，P=0.016），在ODI方面6个月时表现更差（24.5对17.9，P=0.005），且在PCS方面达到MCID的可能性更小（48.8%对64.4%，P=0.041）。然而，在控制年龄、BMI、糖尿病和CCI后，多变量回归未发现上腰椎减压与1年VAS背部评分、6个月ODI评分或PCS中MCID的实现独立相关。
接受上腰椎减压的患者PROMs表现更差。然而，多变量分析表明，这些差异归因于合并症负担和BMI，而非手术节段。这表明，在考虑患者基线特征时，外科医生和患者可预期上腰椎减压在疼痛和功能改善方面的效果相似。
