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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]

Background context Comparative studies between open and minimally invasive surgical (MIS) approaches for the treatment of spinal stenosis have mainly investigated immediate postoperative parameters. Purpose We aimed to compare the postoperative improvements in functional and pain scores between open versus MIS lumbar laminotomy and to describe the complications of each method. Study design/setting We conducted as retrospective review of prospectively collected data. Patient sample We included 113 patients. Outcome measures Visual analog scale for back and leg pain, Oswestry Disability Index (ODI), the North American Spine Society score on neurogenic symptoms (NS), and average Short Form Health Survey-36 (SF-36) score. Accidental durotomies and patients with reoperations are presented. Methods We obtained a list of patients who underwent either MIS or open unilateral one-level lumbar laminotomy for the treatment of neural foraminal or lateral recess stenosis with unilateral leg NS. Outcome measures are presented at 6 and 24 months postoperatively. Results From 2000 to 2008, 113 patients (30 open, 83 MIS) underwent a one-level lumbar laminotomy and had complete postoperative data available for analysis. Between the approaches, there were no differences in baseline demographic data or functional scores. At 6 and 24 months after surgery, there were no differences in improvement in back or leg pain, or improvement in ODI, NS, or SF-36 scores. The MIS group reported greater satisfaction with treatment at 6 months (p=.009) but not at 24 months. Within the MIS group, three patients (3.6%) experienced an inadvertent durotomy and two patients (2.4%) underwent fusion of the operated segment within 24 months. Conclusions Compared with an open approach, MIS lumbar laminotomy gave no clear advantages in longer term functional or pain scores. The MIS group also had patients with inadvertent durotomies and reoperation within 2 years. In any lumbar decompressive surgery, the purported advantages of an MIS approach should be carefully weighed against potential complications. For a relatively simple surgery such as laminotomy, the open approach remains a safe and straightforward option. [ABSTRACT FROM AUTHOR]

Abstract: Background context: Multilevel cervical myelopathy can be treated with anterior cervical discectomy and fusion (ACDF) or corpectomy via the anterior approach and laminoplasty via the posterior approach. Till date, there is no proven superior approach. Purpose: To elucidate any potential advantage of one approach over the other with regard to clinical midterm outcomes in this study. Study design: A prospective, 2-year follow-up of patients with cervical myelopathy treated with multilevel anterior cervical decompression fusion and plating and posterior laminoplasty. Patient sample: In total, 116 patients were studied. Sixty-four patients underwent ACDF two levels and above or anterior cervical corpectomy and fusion one level and above. Fifty-two patients underwent posterior cervical surgery (laminoplasty C3–C6 and C3–C7). Outcome measures: Self-report measures: Japan Orthopedic Association (JOA) score, JOA recovery rate, visual analog scale for neck pain (VASNP), neck disability index (NDI), and American Academy of Orthopaedic Surgeons (AAOS) neurogenic symptom score (AAOS-NSS). Physiologic measures: range of motion (ROM) flexion and extension of neck. Functional measures: short-form 36 (SF-36) score comprising physical functioning, physical role function, bodily pain, general health, vitality, social role function, emotional role function, and mental health scales. Methods: Comparison of the JOA scores, JOA recovery rates, NDI scores, SF-36 scores, VASNP, and ROM preoperatively to 2 years. Chi-square and two-sided Student t tests were used to analyze the variables. Results: Posterior surgery took an hour shorter (p<.05) and had better improvement in JOA scores at early follow-up of 6 months (p=.025). Anterior surgery group had better improvement of NDI scores at early follow-up of 6 months (p=.024) and was associated with less blood loss intraoperatively compared with posterior surgery. There was no statistical difference between the two groups for JOA scores, JOA recovery rates, SF-36 quality-of-life scores, NDI, AAOS-NSS, VAS neck pain, and ROM at 2 years. Complications were higher for anterior surgery group: two hematoma postoperation, one vocal cord paresis, and one new onset C6/C7 dermatome numbness versus one dura leak in posterior surgery group. Conclusions: Our study showed that patients with multilevel disease treated with laminoplasty do well and compare favorably with patients treated with an anterior approach. Notably, posterior surgery was associated with shorter operating time, better improvement in JOA scores at 6 months, and a tendency toward lesser complications. Posterior surgery was not associated with increased neck disability and neck pain at 2 years. Anterior surgery had better NDI improvement at early follow-up. There is a need for a larger study that is prospectively randomized with long-term follow-up before we can confidently advocate one approach over the other in the management of cervical myelopathy. [Copyright &y& Elsevier]