NDI &lt;21 Denotes Patient Acceptable Symptom State After Degenerative Cervical Spine Surgery

Shahi, Pratyush; Subramanian, Tejas; Singh, Nishtha; Shinn, Daniel; Dalal, Sidhant; Song, Junho; Araghi, Kasra; Melissaridou, Dimitra; Sheha, Evan; Dowdell, James; Qureshi, Sheeraz A.; Iyer, Sravisht

doi:10.1097/brs.0000000000004493

Cited by 14 publications

(8 citation statements)

References 21 publications

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“…Our outcome measures of MCID, PASS, and GRC are associated with a few drawbacks. MCID and PASS have been shown to be dependent on the preoperative baseline, 34 and GRC has been associated with recall bias. 35 Finally, we believe that spinal robotics is still evolving and advancing and, as such, continuous research is required to establish its full utility and potential.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Robotics and Navigation for Clinical Outcomes Following Minimally Invasive Lumbar Fusion

Shahi

Subramanian

Araghi

et al. 2023

Spine

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Study Design. Retrospective cohort. Objective. To compare navigation and robotics in terms of clinical outcomes after minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Summary of Background Data. Although robotics has been shown to have advantages like reduced radiation exposure, greater screw size, and slightly better accuracy over navigation, none of the studies has compared these two modalities in terms of clinical outcomes. Methods. Patients who underwent single-level MI-TLIF using robotics or navigation and had a minimum of 1-year follow-up were included. The robotics and navigation groups were compared for improvement in patient-reported outcome measures (PROMs), minimal clinically important difference, patient-acceptable symptom state, response on the global rating change scale, and screwrelated complication and reoperation rates. Results. A total of 278 patients (143 robotics, 135 navigation) were included. There was no significant difference between the robotics and navigation groups in the baseline demographics, operative variables, and preoperative PROMs. Both groups showed significant improvement in PROMs at below six and six months or above, with no significant difference in the magnitude of improvement between the two groups. Most patients achieved minimal clinically important difference and patient-acceptable symptom state and reported feeling better on the global rating change scale, with no significant difference in the proportions between the robotics and navigation groups. The screw-related complication and reoperation rates also showed no significant difference between the two groups. Conclusions. Robotics did not seem to lead to significantly better clinical outcomes compared with navigation following MI-TLIF. Although the clinical outcomes may be similar, robotics offers the advantages of reduced radiation exposure, greater screw size, and slightly better accuracy over navigation. These advantages should be considered when determining the utility and cost-effectiveness of robotics in spine surgery. Larger multicenter prospective studies are required in the future to further investigate this subject.

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Section: Discussionmentioning

confidence: 99%

Comparison of Robotics and Navigation for Clinical Outcomes Following Minimally Invasive Lumbar Fusion

Shahi

Subramanian

Araghi

et al. 2023

Spine

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“…The anchor used to assess the achievement of patient improvement 1 year after surgery was the response on the GRC: 17 “Compared to preoperative, you feel (1) much better, (2) slightly better, (3) same, (4) slightly worse, or (5) much worse.” For the analyses, the 5-point Likert scale of the GRC was collapsed to a dichotomous outcome variable and 2 patient cohorts were developed: (a) improved = response of 1 or 2, (b) not improved = response of 3 or 4 or 5 5,6 …”

Section: Methodsmentioning

confidence: 99%

“…For the analyses, the 5-point Likert scale of the GRC was collapsed to a dichotomous outcome variable and 2 patient cohorts were developed: (a) improved = response of 1 or 2, (b) not improved = response of 3 or 4 or 5. 5,6…”

Section: Anchor Questionmentioning

confidence: 99%

“…PASS is an absolute postoperative ODI score, unlike MCID which is a change score, at which patients are expected to achieve an acceptable symptom state. Although PASS as a concept does seem to address some of the issues around MCID, its utility in spine surgery has only been recently investigated [3][4][5][6] and its efficacy in comparison to MCID remains unexplored. As a result, although we have these 2 metrics for the clinical interpretation of ODI, it is still unclear if there is a clear better metric between the two and if not, which metric should be utilized when.…”

mentioning

confidence: 99%

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Preoperative Disability Influences Effectiveness of MCID and PASS in Predicting Patient Improvement Following Lumbar Spine Surgery

Shahi,

Subramanian,

Maayan

et al. 2023

Clinical Spine Surgery: A Spine Publication

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Study Design: Retrospective cohort. Summary of Background Data: Although minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) are utilized to interpret Oswestry Disability Index (ODI), it is unclear whether there is a clearly better metric between the two and if not, which metric should be utilized when. Objective: To compare the characteristics of MCID and PASS when interpreting ODI after lumbar spine surgery. Methods: Patients who underwent primary minimally invasive transforaminal lumbar interbody fusion or decompression were included. The ODI and global rating change data at 1 year were analyzed. The global rating change was collapsed to a dichotomous outcome variable—(a) improved, (b) not improved The sensitivity, specificity, positive predictive value and negative predictive value of MCID and PASS were calculated for the overall cohort and separately for patients with minimal, moderate, and severe preoperative disability. Two groups with patients who achieved PASS but not MCID and patients who achieved MCID but not PASS were analyzed. Results: Two hundred twenty patients (mean age 62 y, 57% males) were included. PASS (86% vs. 69%) and MCID (88% vs. 63%) had significantly greater sensitivity in patients with moderate and severe preoperative disability, respectively. Nineteen percent of patients achieved PASS but not MCID and 10% of patients achieved MCID but not PASS, with the preoperative ODI being significantly greater in the latter. Most of these patients still reported improvement with no significant difference between the 2 groups (93% vs. 86%). Conclusion: Significant postoperative clinical improvement is most effectively assessed by PASS in patients with minimal or moderate preoperative disability and by MCID in patients with severe preoperative disability. Adequate interpretation of ODI using the PASS and MCID metrics warrants individualized application as their utility is highly dependent on the degree of preoperative disability.

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“…trauma and tumors), and revision surgeries were all excluded. All surgeries were performed as previously described in the literature 10–13 …”

Section: Methodsmentioning

confidence: 99%

Recovery Kinetics Following Cervical Spine Surgery

Subramanian,

Shinn,

Korsun

et al. 2023

Spine

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Study Design. Retrospective review of a prospectively maintained multi-surgeon registry. Objective. To study recovery kinetics and associated factors following cervical spine surgery. Summary of Background Data. Few studies have described return to activities cervical spine surgery. This is a big gap in the literature as preoperative counseling and expectations before surgery are important. Materials and Methods. Patients that underwent either anterior cervical discectomy and fusion (ACDF) or cervical disc replacement (CDR) were included. Data collected included preoperative patient-reported outcome measures, return to driving, return to working, and discontinuation of opioids data. A multivariable regression was conducted to identify the factors associated with return to driving by 15 days, return to working by 15 days, and for discontinuing opioids by 30 days. Results. 70 ACDF patients and 70 CDR patients were included. Overall, 98.2% of ACDF patients and 98% of CDR patients returned to driving in 16 and 12 days, respectively; 85.7% of ACDF patients and 90.9% of CDR patients returned to work in 16 and 14 days; and 98.3% of ACDF patients and 98.3% of CDR patients discontinued opioids in a median of 7 and 6 days. Though not significant, minimal (odds ratio (OR)=1.65) and moderate (OR=1.79) disability was associated with greater odds of returning to driving by 15 days. Sedentary work (OR=0.8) and preoperative narcotics (OR=0.86) were associated with decreased odds of returning to driving by 15 days. Medium (OR=0.81) and heavy (OR=0.78) intensity occupations were associated with decreased odds of returning to work by 15 days. High school education (OR=0.75), sedentary work (OR=0.79), retired/not working (OR=0.69) were all associated with decreased odds of discontinuing opioids by 30 days. Conclusion. Recovery kinetics for ACDF and CDR as comparable. Most patients return to all activities following ACDF and CDR, within 16 days. These findings serve as an important compass for preoperative counseling.

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NDI <21 Denotes Patient Acceptable Symptom State After Degenerative Cervical Spine Surgery

Cited by 14 publications

References 21 publications

Comparison of Robotics and Navigation for Clinical Outcomes Following Minimally Invasive Lumbar Fusion

Comparison of Robotics and Navigation for Clinical Outcomes Following Minimally Invasive Lumbar Fusion

Preoperative Disability Influences Effectiveness of MCID and PASS in Predicting Patient Improvement Following Lumbar Spine Surgery

Recovery Kinetics Following Cervical Spine Surgery

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