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Using Oswestry Disability Index as a Preoperative Surgical Eligibility Criterion for Patients Requiring Lumbar Fusion for Degenerative Lumbar Spine Disease – Lumbar Fusion

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The article discusses a retrospective cohort study that evaluates how preoperative Oswestry Disability Index (ODI) thresholds affect minimal clinically important difference (MCID) achievement following lumbar fusion. The study found that patients with poorer preoperative ODI are significantly more likely to achieve MCID following lumbar spine fusion at all ODI thresholds. Setting a preoperative ODI threshold for surgical eligibility may restrict access to patients who could benefit from spine fusion. The findings suggest that ODI>20 demonstrates the lowest predictive value for MCID achievement. The study highlights the importance of considering patient-reported outcomes in reimbursement approvals for orthopedic procedures and the impact on patient outcomes

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most experienced spinal facility on Harley Street UK

Published article

: Patients with poorer preoperative ODI are significantly more likely to achieve MCID following lumbar spine fusion at all ODI thresholds. Setting a preoperative ODI threshold for surgical eligibility will restrict access to patients who may benefit from spine fusion, despite ODI>20 demonstrating the lowest predictive value for MCID achievement.

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Spine (Phila Pa 1976). 2024 Feb 29. doi: 10.1097/BRS.0000000000004972. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective cohort study.OBJECTIVE: To evaluate how preoperative Oswestry Disability Index (ODI) thresholds might affect minimal clinically important difference (MCID) achievement following lumbar fusion.SUMMARY OF BACKGROUND DATA: As payers invest in alternative payment models, some are suggesting threshold cutoffs of patient reported,

Spine (Phila Pa 1976). 2024 Feb 29. doi: 10.1097/BRS.0000000000004972. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: To evaluate how preoperative Oswestry Disability Index (ODI) thresholds might affect minimal clinically important difference (MCID) achievement following lumbar fusion.

SUMMARY OF BACKGROUND DATA: As payers invest in alternative payment models, some are suggesting threshold cutoffs of patient reported outcomes (PROMs) in reimbursement approvals for orthopedic procedures. The feasibility of this has not been investigated in spine surgery.

MATERIALS/METHODS: We included all adult patients undergoing 1-3 level primary lumbar fusion at a single urban tertiary academic center from 2014-2020. ODI was collected preoperatively and one-year postoperatively. We implemented theoretical threshold cutoffs at increments of 10. MCID was set at 14.3. The percent of patients meeting MCID were determined among patients “approved” or “denied” at each threshold. At each threshold, the positive predictive value (PPV) for MCID attainment was calculated.

RESULTS: A total 1,368 patients were included and 62.4% (N=364) achieved MCID. As the ODI thresholds increased, a greater percent of patients in each group reached the MCID. At the lowest ODI threshold, 6.58% (N=90) of patients would be denied, rising to 20.2%, 39.5%, 58.4%, 79.9%, and 91.4% at ODI thresholds of 30, 40, 50, 60, and 70, respectively. The PPV increased from 0.072 among patients with ODI>20 to 0.919 at ODI>70. The number of patients denied a clinical improvement in the denied category per patient achieving the MCID increased at each threshold (ODI>20: 1.96; ODI>30: 2.40; ODI>40: 2.75; ODI>50: 3.03; ODI>60: 3.54; ODI>70: 3.75).

: Patients with poorer preoperative ODI are significantly more likely to achieve MCID following lumbar spine fusion at all ODI thresholds. Setting a preoperative ODI threshold for surgical eligibility will restrict access to patients who may benefit from spine fusion, despite ODI>20 demonstrating the lowest predictive value for MCID achievement.

PMID:38420655 | DOI:10.1097/BRS.0000000000004972

The London Spine Unit : most experienced spinal facility on Harley Street UK

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Using Oswestry Disability Index as a Preoperative Surgical Eligibility Criterion for Patients Requiring Lumbar Fusion for Degenerative Lumbar Spine Disease

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Spine (Phila Pa 1976). 2024 Feb 29. doi: 10.1097/BRS.0000000000004972. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective cohort study.OBJECTIVE: To evaluate how preoperative Oswestry Disability Index (ODI) thresholds might affect minimal clinically important difference (MCID) achievement following lumbar fusion.SUMMARY OF BACKGROUND DATA: As payers invest in alternative payment models, some are suggesting threshold cutoffs of patient reported

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