Utility of minimum clinically important difference in assessing pain, disability, and health state after transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Outcome studies for spine surgery rely on patient-reported outcomes (PROs) to assess treatment effects. Commonly used health-related quality-of-life questionnaires include the following scales: back pain and leg pain visual analog scale (BP-VAS and LP-VAS); the Oswestry Disability Index (ODI); and the EuroQol-5D health survey (EQ-5D). A shortcoming of these questionnaires is that their numerical scores lack a direct meaning or clinical significance. Because of this, the concept of the minimum clinically important difference (MCID) has been put forth as a measure for the critical threshold needed to achieve treatment effectiveness. By this measure, treatment effects reaching the MCID threshold value imply clinical significance and justification for implementation into clinical practice.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>In 45 consecutive patients undergoing transforaminal lumbar interbody fusion (TLIF) for low-grade degenerative lumbar spondylolisthesis-associated back and leg pain, PRO questionnaires measuring BP-VAS, LPVAS, ODI, and EQ-5D were administered preoperatively and at 2 years postoperatively, and 2-year change scores were calculated. Four established anchor-based MCID calculation methods were used to calculate MCID, as follows: 1) average change; 2) minimum detectable change (MDC); 3) change difference; and 4) receiver operating characteristic curve analysis for two separate anchors (the health transition index [HTI] of the 36-Item Short Form Health Survey [SF-36], and the satisfaction index).</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>All patients were available at the 2-year follow-up. The 2-year improvements in BP-VAS, LP-VAS, ODI, and EQ-5D scores were 4.3 ± 2.9, 3.8 ± 3.4, 19.5 ± 11.3, and 0.43 ± 0.44, respectively (mean ± SD). The 4 MCID calculation methods generated a range of MCID values for each of the PROs (BP-VAS, 2.1–5.3; LP-VAS, 2.1–4.7; ODI, 11–22.9; and EQ-5D, 0.15–0.54). The mean area under the curve (AUC) for the receiver operating characteristic curve from the 4 PRO-specific calculations was greater for the HTI versus satisfaction anchor (HTI [AUC 0.73] vs satisfaction [AUC 0.69]), suggesting HTI as a more accurate anchor.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The TLIF-specific MCID is highly variable based on calculation technique. The MDC approach with the SF-36 HTI anchor appears to be most appropriate for calculating MCID 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 least affected by the choice of anchor. Based on the MDC method with HTI anchor, MCID scores following TLIF are 2.1 points for BP-VAS, 2.8 points for LP-VAS, 14.9 points for ODI, and 0.46 quality-adjusted life years for EQ-5D.</jats:p></jats:sec>

Impact of sagittal spinopelvic alignment on clinical outcomes after decompression surgery for lumbar spinal canal stenosis without coronal imbalance

“…In our study, 41 (53.9%) of 76 patients in Group C and 15 (45.4%) of 33 patients in Group D met this threshold. 6,[19][20][21] The number of patients who met the MCID for these instruments was greater in Group C than in Group D; however, there were no significant differences between the 2 groups. We could not assess how many patients met the MCID for the JOABPEQ in the 2 groups because no studies have assessed the MCID for the JOABPEQ in the lumbar degenerative diseases.…”

Six-month outcomes from a randomized controlled trial of minimally invasive SI joint fusion with triangular titanium implants vs conservative management

“…Although they were developed for degenerative spinal conditions other than SIJ and the effects of SIJF, the MCID for improvement in chronic back pain is approximately 20 % when measured by VAS [46] and that for ODI is approximately 13-15 points [47]. For EQ-5D, the MCID is less well defined, with changes of 0.15-0.46 reported [44,48]. Observed mean values in our study exceeded these MCID values for pain, ODI and EQ-5D, and response rates were markedly higher in the SIJF group compared to CM.…”

Determinants of outcome in lumbar spinal stenosis surgery

“…In a spine register, Solberg et al (2013) recently showed EQ-5D scores to lack specificity and sensitivity and that change corresponding to a level of 0.30 or more, indicates a success of the surgery. Parker et al (2011) have also shown the minimally clinical important difference in terms of EQ-5D to vary considerably in different conditions, so that no specific general value could be provided.…”