PMID- 36122296
OWN - NLM
STAT- MEDLINE
DCOM- 20230110
LR  - 20230111
IS  - 1528-1159 (Electronic)
IS  - 0362-2436 (Linking)
VI  - 48
IP  - 3
DP  - 2023 Feb 1
TI  - ODI <25 Denotes Patient Acceptable Symptom State After Minimally Invasive Lumbar 
      Spine Surgery.
PG  - 196-202
LID - 10.1097/BRS.0000000000004479 [doi]
AB  - STUDY DESIGN: Retrospective review of prospectively collected data. OBJECTIVE: To 
      determine the Oswestry Disability Index (ODI) cutoff for achieving Patient 
      Acceptable Symptom State (PASS) at one year following minimally invasive lumbar 
      spine surgery. SUMMARY OF BACKGROUND DATA: An absolute score denoting PASS, 
      rather than a change score denoting minimal clinically important difference 
      (MCID), might be a better metric to assess clinical outcomes. MATERIALS AND 
      METHODS: Patients who underwent primary minimally invasive transforaminal lumbar 
      interbody fusion or decompression were included. The outcome measure was ODI. The 
      anchor question was the Global Rating Change: "Compared with preoperative, you 
      feel (1) much better, (2) slightly better, (3) same, (4) slightly worse, or (5) 
      much worse." For analysis, it was collapsed to a dichotomous outcome variable 
      (acceptable=response of 1 or 2, unacceptable=response of 3, 4, or 5). Proportion 
      of patients achieving PASS and the ODI cutoff using receiver operating 
      characteristic curve analyses were assessed for the overall cohort as well as 
      subgroups based on age, sex, type of surgery, and preoperative ODI. Differences 
      between the PASS and MCID metrics were analyzed. RESULTS: A total of 137 patients 
      were included. In all, 87% of patients achieved PASS. Patients less than or equal 
      to 65 years and those undergoing fusion were more likely to achieve PASS. The 
      receiver operating characteristic curve analysis revealed an ODI cutoff of 25.2 
      to achieve PASS (area under the curve: 0.872, sensitivity: 82%, specificity: 
      83%). The subgroup analyses based on age, sex, and preoperative ODI revealed area 
      under the curve >0.8 and ODI threshold values consistent between 25.2 and 25.5 
      (except 28.4 in patients with preoperative ODI >40). PASS was found to have 
      significantly higher sensitivity compared with MCID (82% vs. 69%, P =0.01). 
      CONCLUSIONS: Patients with ODI <25 are expected to achieve PASS, irrespective of 
      age, sex, and preoperative disability. PASS was found to have significantly 
      higher sensitivity than MCID. LEVEL OF EVIDENCE: 3.
CI  - Copyright (c) 2022 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Shahi, Pratyush
AU  - Shahi P
AD  - Hospital for Special Surgery, New York, NY.
FAU - Shinn, Daniel
AU  - Shinn D
AD  - Hospital for Special Surgery, New York, NY.
AD  - Weill Cornell Medical College, New York, NY.
FAU - Singh, Nishtha
AU  - Singh N
AD  - Hospital for Special Surgery, New York, NY.
FAU - Subramanian, Tejas
AU  - Subramanian T
AD  - Hospital for Special Surgery, New York, NY.
AD  - Weill Cornell Medical College, New York, NY.
FAU - Song, Junho
AU  - Song J
AD  - Hospital for Special Surgery, New York, NY.
FAU - Dalal, Sidhant
AU  - Dalal S
AD  - Hospital for Special Surgery, New York, NY.
FAU - Araghi, Kasra
AU  - Araghi K
AD  - Hospital for Special Surgery, New York, NY.
FAU - Melissaridou, Dimitra
AU  - Melissaridou D
AD  - Hospital for Special Surgery, New York, NY.
FAU - Sheha, Evan
AU  - Sheha E
AD  - Hospital for Special Surgery, New York, NY.
FAU - Dowdell, James
AU  - Dowdell J
AD  - Hospital for Special Surgery, New York, NY.
FAU - Qureshi, Sheeraz A
AU  - Qureshi SA
AUID- ORCID: 0000-0002-7177-1756
AD  - Hospital for Special Surgery, New York, NY.
AD  - Weill Cornell Medical College, New York, NY.
FAU - Iyer, Sravisht
AU  - Iyer S
AD  - Hospital for Special Surgery, New York, NY.
AD  - Weill Cornell Medical College, New York, NY.
LA  - eng
PT  - Journal Article
DEP - 20220916
PL  - United States
TA  - Spine (Phila Pa 1976)
JT  - Spine
JID - 7610646
SB  - IM
MH  - Humans
MH  - Treatment Outcome
MH  - *Lumbar Vertebrae/surgery
MH  - Minimal Clinically Important Difference
MH  - Minimally Invasive Surgical Procedures/adverse effects
MH  - Surveys and Questionnaires
MH  - Retrospective Studies
MH  - *Spinal Fusion/adverse effects
COIS- The authors report no conflicts of interest.
EDAT- 2022/09/20 06:00
MHDA- 2023/01/11 06:00
CRDT- 2022/09/19 15:32
PHST- 2022/07/22 00:00 [received]
PHST- 2022/09/07 00:00 [accepted]
PHST- 2022/09/20 06:00 [pubmed]
PHST- 2023/01/11 06:00 [medline]
PHST- 2022/09/19 15:32 [entrez]
AID - 00007632-202302010-00008 [pii]
AID - 10.1097/BRS.0000000000004479 [doi]
PST - ppublish
SO  - Spine (Phila Pa 1976). 2023 Feb 1;48(3):196-202. doi: 
      10.1097/BRS.0000000000004479. Epub 2022 Sep 16.