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

Abstract

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.

The attainment of a patient acceptable symptom state in patients undergoing revision spine fusion

“…Especially among patients undergoing revision spine surgery, the benefits of surgery are significant even if the absolute symptom state is not considered acceptable in some patient populations [34,35]. Recently, Shahi et al suggested postoperative improvement is best assessed by PASS in patients with minimal or moderate preoperative disability while MCID is an optimal metric for patients with severe preoperative disability [36]. In their population of 212 primary minimally invasive spine fusion patients, 19% achieved PASS but not MCID and 10% of achieved MCID but not PASS, with primary difference being a poorer preoperative ODI in the second group.…”