The SF-36 fails to satisfy the measurement needs of cervical spine surgeons. Scale scores are valid, but floor and ceiling effects mean that changes in quality of life associated with surgery are underestimated. SF-36 summary scores are not valid. Neurosurgeons need better and more sophisticated scales to measure their outcomes.
In this small study, X-STOP appeared safe and effective. It is less invasive than other established surgical procedures, but does not jeopardise other options in the event of failure. Large scale clinical trials are justified but floor and ceiling effects suggest that the ODI and SF-36 may not be the best choice of outcome measures for those studies.
In this small sample, from two units, NICE's description of the clinical manifestations of lumbar nerve root compression did not describe 99% of people having surgery for it. Using NICE's definition to triage people with low back pain could result in prolonged symptoms and delayed treatment. Diagnosing lumbar nerve root compression is complex. NICE's guidance requires examination.
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