PMID- 21962034
OWN - NLM
STAT- MEDLINE
DCOM- 20120216
LR  - 20220317
IS  - 1547-5646 (Electronic)
IS  - 1547-5646 (Linking)
VI  - 16
IP  - 1
DP  - 2012 Jan
TI  - Determination of minimum clinically important difference in pain, disability, and 
      quality of life after extension of fusion for adjacent-segment disease.
PG  - 61-7
LID - 10.3171/2011.8.SPINE1194 [doi]
AB  - OBJECT: Spinal surgical outcome studies rely on patient-reported outcome (PRO) 
      measurements to assess treatment effect. A shortcoming of these questionnaires is 
      that the extent of improvement in their numerical scores lack a direct clinical 
      meaning. As a result, the concept of minimum clinical important difference (MCID) 
      has been used to measure the critical threshold needed to achieve clinically 
      relevant treatment effectiveness. As utilization of spinal fusion has increased 
      over the past decade, so has the incidence of adjacent-segment degeneration 
      following index lumbar fusion, which commonly requires revision laminectomy and 
      extension of fusion. The MCID remains uninvestigated for any PROs in the setting 
      of revision lumbar surgery for adjacent-segment disease (ASD). METHODS: In 50 
      consecutive patients undergoing revision surgery for ASD-associated back and leg 
      pain, PRO measures of back and leg pain on a visual analog scale (BP-VAS and 
      LP-VAS, respectively), Oswestry Disability Index (ODI), 12-Item Short Form Health 
      Survey Physical and Mental Component Summaries (SF-12 PCS and MCS, respectively), 
      and EuroQol-5D health survey (EQ-5D) were assessed preoperatively and 2 years 
      postoperatively. The following 4 well-established anchor-based MCID calculation 
      methods were used to calculate MCID: average change; minimum detectable change 
      (MDC); change difference; and receiver operating characteristic curve (ROC) 
      analysis for the following 2 separate anchors: health transition item (HTI) of 
      the SF-36 and satisfaction index. RESULTS: All patients were available for 2-year 
      PRO assessment. Two years after surgery, a statistically significant improvement 
      was observed for all PROs (mean changes: BP-VAS score [4.80 +/- 3.25], LP-VAS score 
      [3.28 +/- 3.25], ODI [10.24 +/- 13.49], SF-12 PCS [8.69 +/- 12.55] and MCS [8.49 +/- 
      11.45] scores, and EQ-5D [0.38 +/- 0.45]; all p < 0.001). The 4 MCID calculation 
      methods generated a range of MCID values for each of the PROs (BP-VAS score, 
      2.3-6.5; LP-VAS score, 1.7-4.3; ODI, 6.8-16.9; SF-12 PCS, 6.1-12.6; SF-12 MCS, 
      2.4-10.8; and EQ-5D, 0.27-0.54). The area under the ROC curve was consistently 
      greater for the HTI anchor than the satisfaction anchor, suggesting this as a 
      more accurate anchor for MCID. CONCLUSIONS: Adjacent-segment disease revision 
      surgery-specific MCID is highly variable based on calculation technique. The MDC 
      approach with HTI anchor appears to be most appropriate for calculation of MCID 
      after revision lumbar fusion for ASD because it provided a threshold above the 
      95% CI of the unimproved cohort (greater than the measurement error), was closest 
      to the mean change score reported by improved and satisfied patients, and was not 
      significantly affected by choice of anchor. Based on this method, MCID following 
      ASD revision lumbar surgery is 3.8 points for BP-VAS score, 2.4 points for LP-VAS 
      score, 6.8 points for ODI, 8.8 points for SF-12 PCS, 9.3 points for SF-12 MCS, 
      and 0.35 quality-adjusted life-years for EQ-5D.
FAU - Parker, Scott L
AU  - Parker SL
AD  - Departments of Neurosurgery and Orthopedic Surgery, Vanderbilt University Medical 
      Center, Nashville, Tennessee, USA.
FAU - Mendenhall, Stephen K
AU  - Mendenhall SK
FAU - Shau, David
AU  - Shau D
FAU - Adogwa, Owoicho
AU  - Adogwa O
FAU - Cheng, Joseph S
AU  - Cheng JS
FAU - Anderson, William N
AU  - Anderson WN
FAU - Devin, Clinton J
AU  - Devin CJ
FAU - McGirt, Matthew J
AU  - McGirt MJ
LA  - eng
PT  - Journal Article
DEP - 20110930
PL  - United States
TA  - J Neurosurg Spine
JT  - Journal of neurosurgery. Spine
JID - 101223545
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Back Pain/*surgery
MH  - Disability Evaluation
MH  - Disabled Persons
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Lumbar Vertebrae/*surgery
MH  - Male
MH  - Middle Aged
MH  - Pain Measurement
MH  - Patient Satisfaction
MH  - *Quality of Life
MH  - Spinal Fusion/*methods
MH  - Spinal Stenosis/*surgery
EDAT- 2011/10/04 06:00
MHDA- 2012/02/18 06:00
CRDT- 2011/10/04 06:00
PHST- 2011/10/04 06:00 [entrez]
PHST- 2011/10/04 06:00 [pubmed]
PHST- 2012/02/18 06:00 [medline]
AID - 10.3171/2011.8.SPINE1194 [doi]
PST - ppublish
SO  - J Neurosurg Spine. 2012 Jan;16(1):61-7. doi: 10.3171/2011.8.SPINE1194. Epub 2011 
      Sep 30.