PMID- 37160168
OWN - NLM
STAT- MEDLINE
DCOM- 20230828
LR  - 20230914
IS  - 1878-1632 (Electronic)
IS  - 1529-9430 (Linking)
VI  - 23
IP  - 9
DP  - 2023 Sep
TI  - Determining minimal clinically important difference estimates following surgery 
      for degenerative conditions of the lumbar spine: analysis of the Canadian Spine 
      Outcomes and Research Network (CSORN) registry.
PG  - 1323-1333
LID - S1529-9430(23)00192-4 [pii]
LID - 10.1016/j.spinee.2023.05.001 [doi]
AB  - BACKGROUND CONTEXT: There is significant variability in minimal clinically 
      important difference (MCID) criteria for lumbar spine surgery that suggests 
      population and primary pathology specific thresholds may be required to help 
      determine surgical success when using patient reported outcome measures (PROMs). 
      PURPOSE: The purpose of this study was to estimate MCID thresholds for 3 commonly 
      used PROMs after surgical intervention for each of 4 common lumbar spine 
      pathologies. STUDY DESIGN/SETTING: Observational longitudinal study of patients 
      from the Canadian Spine Outcomes and Research Network (CSORN) national registry. 
      PATIENT SAMPLE: Patients undergoing surgery from 2015 to 2018 for lumbar spinal 
      stenosis (LSS; n = 856), degenerative spondylolisthesis (DS; n = 591), disc 
      herniation (DH; n = 520) or degenerative disc disease (DDD n = 185) were 
      included. OUTCOME MEASURES: PROMs were collected presurgery and 1-year 
      postsurgery: the Oswestry Disability Index (ODI), and back and leg Numeric Pain 
      Rating Scales (NPRS). At 1-year, patients reported whether they were 'Much 
      better'/'Better'/'Same'/'Worse'/'Much worse' compared to before their surgery. 
      Responses to this item were used as the anchor in analyses to determine surgical 
      MCIDs for benefit ('Much better'/'Better') and substantial benefit ('Much 
      better'). METHODS: MCIDs for absolute and percentage change for each of the 3 
      PROMs were estimated using a receiving operating curve (ROC) approach, with 
      maximization of Youden's index as primary criterion. Area under the curve (AUC) 
      estimates, sensitivity, specificity and correct classification rates were 
      determined. All analyses were conducted separately by pathology group. RESULTS: 
      MCIDs for ODI change ranged from -10.0 (DDD) to -16.9 (DH) for benefit, and -13.8 
      (LSS) to -22.0 (DS,DH) for substantial benefit. MCID for back and leg NPRS change 
      were -2 to -3 for each group for benefit and -4.0 for substantial benefit for all 
      groups on back NPRS. MCID estimates for percentage change varied by PROM and 
      pathology group, ranging from -11.1% (ODI for DDD) to -50.0% (leg NPRS for DH) 
      for benefit and from -40.0% (ODI for DDD) to -66.6% (leg NPRS for DH) for 
      substantial benefit. Correct classification rates for all MCID thresholds ranged 
      from 71% to 89% and were relatively lower for absolute vs percent change for 
      those with high or low presurgical scores. CONCLUSIONS: Our findings suggest that 
      the use of generic MCID thresholds across pathologies in lumbar spine surgery is 
      not recommended. For patients with relatively low or high presurgery PROM scores, 
      MCIDs based on percentage change, rather than absolute change, appear generally 
      preferable. These findings have applicability in clinical and research settings, 
      and are important for future surgical prognostic work.
CI  - Copyright (c) 2023 The Author(s). Published by Elsevier Inc. All rights reserved.
FAU - Power, J Denise
AU  - Power JD
AD  - Schroeder Arthritis Institute, Krembil Research Institute, University Health 
      Network, 399 Bathurst St, Toronto, Ontario, M5T 2S8, Canada.
FAU - Perruccio, Anthony V
AU  - Perruccio AV
AD  - Schroeder Arthritis Institute, Krembil Research Institute, University Health 
      Network, 399 Bathurst St, Toronto, Ontario, M5T 2S8, Canada; Orthopaedics, 
      Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, 
      M5T 1P5, Canada; Institute of Health Policy, Management and Evaluation, Dalla 
      Lana School of Public Health, University of Toronto, 155 College St 4(th) floor, 
      Toronto, Ontario, M5T 3M6, Canada.
FAU - Canizares, Mayilee
AU  - Canizares M
AD  - Schroeder Arthritis Institute, Krembil Research Institute, University Health 
      Network, 399 Bathurst St, Toronto, Ontario, M5T 2S8, Canada.
FAU - McIntosh, Greg
AU  - McIntosh G
AD  - Canadian Spine Outcomes and Research Network, 10 Armstrong Cresent, Markdale, 
      Ontario N0C 1H0, Canada.
FAU - Abraham, Edward
AU  - Abraham E
AD  - Canada East Spine Center and Horizon Health Network, 400 University Avenue, 3C 
      South, Saint John, New Brunswick, E2L 4L4, Canada.
FAU - Attabib, Najmedden
AU  - Attabib N
AD  - Canada East Spine Centre, Division of Neurosurgery, Zone 2, Horizon Health 
      Network, 400 University Avenue, 3B North, Saint John, New Brunswick E2L 4L4, 
      Canada.
FAU - Bailey, Christopher S
AU  - Bailey CS
AD  - London Health Science Centre Combined Orthopaedic and Neurosurgery Spine Program, 
      Schulich School of Medicine, Western University, 1151 Richmond Street, London, 
      Ontario N6A 5C1, Canada.
FAU - Charest-Morin, Raphaele
AU  - Charest-Morin R
AD  - Combined Neurosurgery and Orthopaedic Spine Program, University of British 
      Columbia, 5959 Student Union Blvd, Vancouver, British Columbia V6T 1K2, Canada.
FAU - Dea, Nicholas
AU  - Dea N
AD  - Combined Neurosurgery and Orthopaedic Spine Program, University of British 
      Columbia, 5959 Student Union Blvd, Vancouver, British Columbia V6T 1K2, Canada.
FAU - Finkelstein, Joel
AU  - Finkelstein J
AD  - Spine Program, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, 
      Ontario M4N 3M5, Canada.
FAU - Fisher, Charles
AU  - Fisher C
AD  - Combined Neurosurgery and Orthopaedic Spine Program, University of British 
      Columbia, 5959 Student Union Blvd, Vancouver, British Columbia V6T 1K2, Canada.
FAU - Glennie, R Andrew
AU  - Glennie RA
AD  - Department of Surgery, Division of Orthopedics, Dalhousie University, 6230 Coburg 
      Rd, Halifax, Nova Scotia B3H 4J5, Canada.
FAU - Hall, Hamilton
AU  - Hall H
AD  - Department of Surgery, University of Toronto, 149 College Street, Room 508-A, 
      Toronto, Ontario M5T 1P5, Canada.
FAU - Johnson, Michael G
AU  - Johnson MG
AD  - Winnipeg Spine Program Health Sciences Centre, University of Manitoba, 820 
      Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada.
FAU - Kelly, Adrienne M
AU  - Kelly AM
AD  - Sault Area Hospital, Northern Ontario School of Medicine, 750 Great Northern Rd, 
      Sault Ste. Marie, Ontario P6B 0A8, Canada.
FAU - Kingwell, Stephen
AU  - Kingwell S
AD  - Division of Orthopaedic Surgery, University of Ottawa, 145 Jean-Jacques-Lussier 
      Private, Ottawa, Ontario K1N 6N5, Canada.
FAU - Manson, Neil
AU  - Manson N
AD  - Canada East Spine Center and Horizon Health Network, 400 University Avenue, 3C 
      South, Saint John, New Brunswick, E2L 4L4, Canada.
FAU - Nataraj, Andrew
AU  - Nataraj A
AD  - Division of Neurosurgery, University of Alberta, 8440 112 St NW, Edmonton, 
      Alberta T6G 2B7, Canada.
FAU - Paquet, Jerome
AU  - Paquet J
AD  - Hopital de L'Enfant-Jesus, Laval University, 401 18E Rue, Quebec City, Quebec G1J 
      1Z4, Canada.
FAU - Singh, Supriya
AU  - Singh S
AD  - London Health Science Centre Combined Orthopaedic and Neurosurgery Spine Program, 
      Schulich School of Medicine, Western University, 1151 Richmond Street, London, 
      Ontario N6A 5C1, Canada.
FAU - Soroceanu, Alex
AU  - Soroceanu A
AD  - University of Calgary Spine Program, University of Calgary, 2500 University Dr, 
      NW, Calgary, Alberta T2N 1N4, Canada.
FAU - Thomas, Kenneth C
AU  - Thomas KC
AD  - University of Calgary Spine Program, University of Calgary, 2500 University Dr, 
      NW, Calgary, Alberta T2N 1N4, Canada.
FAU - Weber, Michael H
AU  - Weber MH
AD  - Division of Orthopaedics, McGill University Health Centre, 3650 Rue Saint-Urbain 
      Bureau K 124, Montreal, Quebec H2X 2P4, Canada.
FAU - Rampersaud, Y Raja
AU  - Rampersaud YR
AD  - Schroeder Arthritis Institute, Krembil Research Institute, University Health 
      Network, 399 Bathurst St, Toronto, Ontario, M5T 2S8, Canada; Orthopaedics, 
      Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, 
      M5T 1P5, Canada. Electronic address: raja.rampersaud@uhn.ca.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20230507
PL  - United States
TA  - Spine J
JT  - The spine journal : official journal of the North American Spine Society
JID - 101130732
SB  - IM
MH  - Humans
MH  - Canada
MH  - Longitudinal Studies
MH  - *Lumbar Vertebrae/surgery
MH  - *Minimal Clinically Important Difference
MH  - Registries
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Disability
OT  - Lumbar spine
OT  - MCID
OT  - Minimal clinically important difference
OT  - Pain
OT  - Surgery
COIS- Declarations of Competing Interest One or more of the authors declare financial 
      or professional relationships on ICMJE-TSJ disclosure forms.
EDAT- 2023/05/10 00:41
MHDA- 2023/08/25 06:42
CRDT- 2023/05/09 19:13
PHST- 2022/10/06 00:00 [received]
PHST- 2023/04/24 00:00 [revised]
PHST- 2023/05/02 00:00 [accepted]
PHST- 2023/08/25 06:42 [medline]
PHST- 2023/05/10 00:41 [pubmed]
PHST- 2023/05/09 19:13 [entrez]
AID - S1529-9430(23)00192-4 [pii]
AID - 10.1016/j.spinee.2023.05.001 [doi]
PST - ppublish
SO  - Spine J. 2023 Sep;23(9):1323-1333. doi: 10.1016/j.spinee.2023.05.001. Epub 2023 
      May 7.