Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Dec 15;41(24):1925-1932.
doi: 10.1097/BRS.0000000000001653.

Surgical Resection of Intradural Extramedullary Spinal Tumors: Patient Reported Outcomes and Minimum Clinically Important Difference

Scott L Zuckerman  1 , Silky Chotai  1 , Clinton J Devin  1 , Scott L Parker  1 , David P Stonko  1 , Joseph B Wick  1 , Andrew T Hale  1 , Matthew J McGirt  2 , Joseph S Cheng  1   3
Affiliations

Surgical Resection of Intradural Extramedullary Spinal Tumors: Patient Reported Outcomes and Minimum Clinically Important Difference

Scott L Zuckerman et al. Spine (Phila Pa 1976). .

Abstract

Study design: Analysis of prospectively collected longitudinal web-based registry data.

Objective: To determine relative validity, responsiveness, and minimum clinically important difference (MCID) thresholds in patients undergoing surgery for intradural extramedullary (IDEM) spinal tumors.

Summary of background data: Patient-reported outcomes (PROs) are vital in establishing the value of care in spinal pathology. There is limited availability of prospective, quality studies reporting PROs for IDEM spine tumors.

Methods: . A total of 40 patients were analyzed. Baseline, postoperative 3-month, and 12-month PROs were recorded: Oswestry Disability Index or Neck disability Index (ODI/NDI), Quality of life EuroQol-5D (EQ-5D), Short Form-12 (SF-12), Numeric Rating Scale (NRS)-pain scores. Responders were defined as those who achieved a level of improvement one or two, after surgery, on health transition index (HTI) of SF-36. Receiver-operating characteristic curves were generated to assess the validity of PROs, and the difference between standardized response means (SRMs) in responders versus nonresponders was utilized to determine the relative responsiveness of each PRO measure. MCID thresholds were derived using previously reported minimal detectable change approach.

Results: A significant improvement across all PROs at 3-months and 12-months follow up was noted. The derived MCID thresholds were 13.9 points: ODI/NDI, 0.14 quality adjusted life years: EQ-5D, 2.8 points: SF-12PCS and 10.7 points: SF-12MCS, 1.9 points: NRS-back/neck pain, and 1.8 points: NRS-leg/arm pain. SF-12PCS was most accurate discriminator of meaningful improvement (area under the curve, AUC-0.83) and most responsive (SRM-1.36) to postoperative improvement. EQ-5D, ODI/NDI, NRS-pain scores were all accurate discriminator (AUC-0.7-0.8) and responsive measures (0.97-0.67) of meaningful postoperative improvement. SF-12MCS was neither a valid discriminator (AUC-0.48) nor a responsive measure (SRM: -1.5) of outcome.

Conclusion: Surgical resection of IDEM spinal tumors provides significant and sustained improvement in quality of life, general health, disability, and pain at 12-month after surgery. The surgically resected IDEM-specific clinically meaningful thresholds are reported. All the PROs reported in this study can accurately discriminate responders and nonresponder based on SF-36 HTI index except for SF-12 MCS.

Level of evidence: 3.

PubMed Disclaimer

References

    1. Devin CJ, Chotai S, Parker SL, et al. A cost-utility analysis of lumbar decompression with and without fusion for degenerative spine disease in the elderly. Neurosurgery 2015; 77:S116–S124.
    1. Larkin DJ, Swanson RC, Fuller S, et al. The Affordable Care Act: a case study for understanding and applying complexity concepts to health care reform. J Eval Clin Pract 2014; 22:133–140.
    1. Asher AL, Speroff T, Dittus RS, et al. The National Neurosurgery Quality and Outcomes Database (N2QOD): a collaborative North American Outcomes Registry to advance value-based spine care. Spine 2014; 39:S106–S116.
    1. McGirt MJ, Parker SL, Asher AL, et al. Role of prospective registries in defining the value and effectiveness of spine care. Spine 2014; 39:S117–S128.
    1. Melloh M, Staub L, Aghayev E, et al. The international spine registry SPINE TANGO: status quo and first results. Eur Spine J 2008; 17:1201–1209.

LinkOut - more resources