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Background Context: The patient acceptable symptom state (PASS) has emerged as a novel tool for interpreting patient-reported outcomes. While the minimal clinically important difference values for various spine outcome instruments have been defined, little is known about the PASS thresholds for these measures.Purpose: To define threshold values on the neck disability index (NDI) corresponding to a PASS in patients undergoing surgery for degenerative disorders of the cervical spine.Study Design: Retrospective review of prospectively collected registry data.Patient Sample: The sample includes 613 patients who underwent anterior cervical discectomy and fusion for degenerative spine conditions between 2005 and 2014.Outcome Measures: The main outcome measure was the NDI. The PASS anchor question was adapted from the NASS questionnaire, "How would you rate the overall results of your treatment?" and the validation question was adapted from the AAOS cervical spine questionnaire, "Would you have the same treatment again if you had the same condition?"Methods: Patients were assessed preoperatively, 6 months and 2 years postoperatively using the NDI. Responses to the anchor question were dichotomized and used as the external criterion in receiver operating characteristics analysis to define thresholds on the NDI that corresponded to a PASS at 2 years postoperatively. Sensitivity analyses were carried out for various subgroups (age, gender, BMI, comorbidity status), baseline NDI (tertiles), time of follow-up (6 months and 2 years) and an alternate definition of PASS.Results: Of the 613 patients, 503 (82%) completed 2-year follow-up, of which, 81% reported their current state as acceptable. The areas under the curve (AUC) for the receiver operating characteristics were 0.75 to 0.89 for all analyses, indicating a good ability of the NDI to discriminate between attaining a satisfactory state or not. The PASS threshold was ≤15 points at 6 months (AUC 0.81, sensitivity 73%, specificity 79%) and ≤17 points at 2 years (AUC 0.80, sensitivity 86%, specificity 65%). Sensitivity analyses revealed that the 17-point threshold on the NDI was robust. PASS responders were approximately 12 times more likely to be satisfied (adjusted odds ratio 12.11, 95% confidence intervals 6.96-21.07) and 6 times more willing to undergo surgery again (adjusted odds ratio 6.12, 95% confidence intervals 3.47-10.80) compared to nonresponders.Conclusions: Patients with a NDI of ≤17 consider their postoperative symptom state to be acceptable. This PASS threshold can be used alongside the minimal clinically important difference when defining treatment success in spine outcomes studies. At the individual level, this threshold provides clinically relevant benchmarks for surgeons when assessing a patient's postoperative recovery. [ABSTRACT FROM AUTHOR]

Background Context: The patient acceptable symptom state (PASS) is a valuable tool for interpreting patient-reported outcomes. Previous studies have attempted to define the PASS in a heterogenous cohort with various lumbar spinal disorders and surgical procedures.Purpose: We aimed to determine the PASS threshold for the Oswestry Disability Index (ODI) specifically for patients undergoing lumbar fusion for spondylolisthesis-associated functional disability.Study Design: Retrospective review of prospectively collected registry data.Patient Sample: There were 692 patients who underwent primary single-level minimally invasive transforaminal lumbar interbody fusion for degenerative spondylolisthesis between 2006 and 2014.Outcome Measures: The ODI was collected pre-operatively, at 6 months and 2 years postoperatively. An anchor question was adapted from the NASS questionnaire, "How would you rate the overall results of your treatment?" while a validation question was taken from the same questionnaire, "Has the surgery for your back condition met your expectations so far?"Methods: Responses to the anchor question were used to determine whether a PASS was achieved. Receiver operating characteristics curve analysis was performed to assess the ability of the ODI to discriminate between an acceptable/unacceptable symptom state as well as to define PASS thresholds. Sensitivity analyses were performed for different follow-up periods (6 months, 2 years), subgroups (by age, gender, BMI, and comorbidity burden), baseline ODI tertiles, and an alternate definition of PASS.Results: In total, 529 of 692 (76%) patients completed 2-year follow-up, of which, 89% considered their symptom state to be acceptable. Areas under the curve (AUC) ranged from 0.81 to 0.90 for all receiver operating characteristics analyses, indicating that the ODI had an excellent discriminative ability. The PASS threshold was ≤18.09 at 6 months (AUC 0.81, sensitivity 77%, specificity 72%) and ≤15.27 at 2 years (AUC 0.86, sensitivity 79%, specificity 79%). These thresholds proved to be robust in the sensitivity analyses, showing minimal variation across different patient subgroups and baseline score tertiles.Conclusions: Patients with an ODI of ≤15.27 can be considered to have achieved a PASS after lumbar fusion for degenerative spondylolisthesis. These findings will help surgeons to contextualize a patient's functional recovery after lumbar spine surgery and enable researchers to define clinically relevant benchmarks when designing trials utilizing the ODI. [ABSTRACT FROM AUTHOR]

Background Context: The patient acceptable symptom state (PASS) has gained attention as a valuable interpretation tool in spine research. While the PASS for the Japanese Orthopaedic Association (JOA) score has been recently proposed, previous analyses demonstrated a weak discriminative ability for the suggested threshold.Purpose: To define the PASS for the JOA score in patients undergoing anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM).Study Design: Retrospective review of prospectively collected registry data.Patient Sample: 378 patients who underwent ACDF for cervical myelopathy between 2005 and 2014.Outcome Measures: The main outcome measure was the JOA score. The PASS anchor question was adapted from the NASS questionnaire, "How would you rate the overall results of your treatment?" and the validation question was adapted from same questionnaire, "Has the surgery for your neck condition met your expectation so far?"Methods: Patients were assessed preoperatively, 6 months and 2 years postoperatively using the JOA. Responses to the anchor question were dichotomized and used as the external criterion in receiver operating characteristics (ROC) analysis to define thresholds on the JOA that corresponded to a PASS at 2 years postoperatively. Sensitivity analyses were carried out for various subgroups (based on age, gender, body mass index, comorbidities), preoperative myelopathy severity, time of follow-up (6 months and 2 years) and an alternate definition of PASS.Results: Of the 378 patients, 312 (83%) completed 2-year follow-up, of which, 78.5% reported their current state as acceptable. The areas under the curve (AUC) for the ROCs were 0.72 to 0.83 for all analyses, indicating a good discriminative ability of the JOA when assessing if a satisfactory state was attained. The PASS threshold was ≥13.25 points at 6 months (AUC 0.74, sensitivity 78%, specificity 59%) and ≥14.25 points at 2 years (AUC 0.76, sensitivity 74%, specificity 66%). Sensitivity analyses revealed that the 14.25-point threshold on the JOA was robust. PASS responders were approximately 6 times more likely to be satisfied (adjusted OR 6.18, 95% CI 2.87-13.30) and 8 times more likely to have their expectation fulfilled (adjusted OR 8.23, 95% CI 3.81-17.77) compared with non-responders.Conclusions: This study validates the PASS threshold of 14.25 on the JOA in a robust analysis of a large cohort undergoing ACDF. This knowledge will enable clinicians to identify patients who have attained a satisfactory functional status after surgery for CSM and allow researchers to interpret studies utilizing the JOA from a patient-centered perspective. [ABSTRACT FROM AUTHOR]