Preoperative Disability Influences Effectiveness of Minimal Clinically Important Difference and Patient Acceptable Symptom State in Predicting Patient Improvement Following Cervical Spine Surgery

Abstract

Study Design Retrospective cohort. Objective To compare the characteristics of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) metrics when interpreting Neck Disability Index (NDI) following cervical spine surgery. Methods Patients who underwent primary cervical fusion, discectomy, or laminectomy were included. NDI and global rating change (GRC) data at 6 months/1 year/2 years were analyzed. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MCID and PASS in predicting improvement on GRC were calculated for the overall cohort and separately for patients with minimal (NDI <30), moderate (NDI 30 – 49), and severe (NDI ≥ 50) preoperative disability. Two groups with patients who achieved PASS but not MCID and patients who achieved MCID but not PASS were analyzed. Results 141 patients (206 responses) were included. PASS had significantly greater sensitivity for the overall cohort (85% vs 73% with MCID, P = .02) and patients with minimal disability (96% vs 53% with MCID, P < .001). MCID had greater sensitivity for patients with severe disability (78% vs 57% with PASS, P = .05). Sensitivity was not significantly different for PASS and MCID in patients with moderate preoperative disability (83% vs 92%, P = .1). 17% of patients achieved PASS but not MCID and 9% of patients achieved MCID but not PASS. Most of these patients still reported improvement with no significant difference between the 2 groups (89% vs 72%, P = .13). Conclusion PASS and MCID are better metrics for patients with minimal and severe preoperative disability, respectively. Both metrics are equally effective for patients with moderate preoperative disability.