Tag: minimal clinically important difference

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Minimal Clinically Important Difference and Relative Change in Patient-Reported Outcomes After Surgery for Cervical Spondylotic Myelopathy: A Nationwide Study of 1,700 Patients

Neurosurgery 98:358–364, 2026

This nationwide registry study of 1,756 patients evaluates minimal clinically important difference (MCID) versus minimal clinically important relative change (MCIRC) for patient-reported outcomes after surgery for degenerative cervical myelopathy. Using anchor-based ROC analyses, the authors derive MCID and MCIRC thresholds for NRS neck/arm pain, EQ-5D index, EQ VAS, and NDI, and compare predictive accuracy for patient satisfaction at one year.

Key findings show MCIRC outperforms absolute MCID for NRS neck and arm pain and NDI, while MCID is superior for EQ-5D index and EQ VAS; selected thresholds are reported (e.g., NRS neck MCID −3 and MCIRC −47%). The study recommends incorporating MCIRC in future spine outcome guidelines to improve individualized assessment.

Minimal Clinically Important Difference (MCID): MCID represents the smallest absolute change in patient-reported outcome measures (PROMs) that signifies meaningful improvement for the patient after cervical spondylotic myelopathy surgery.

Minimal Clinically Important Relative Change (MCIRC): MCIRC is a proportional measure that reflects the minimum relative change in PROMs from baseline, making it more sensitive to changes in patients with extreme baseline values.

Calculation Methods: MCID and MCIRC values were determined using anchor-based approaches (with patient satisfaction as the anchor), ROC curve analysis with the Youden index, minimal detectable change (MDC), and mean change methods.

Key Thresholds Identified: MCID values were −3 for NRS neck pain, −2 for NRS arm pain, 0.09 for EQ5D index, 7 for EQ VAS, and −12 for NDI; MCIRC values were −47% for NRS neck pain, −40% for NRS arm pain, 386% for EQ5D index, 52% for EQ VAS, and −32% for NDI.

Predictive Accuracy: Relative change (MCIRC) provided greater predictive accuracy for identifying patient satisfaction in NRS neck/arm pain and NDI, while absolute difference (MCID) was superior for EQ5D index and EQ VAS.

Clinical Implication: MCIRC is recommended for PROMs influenced by baseline severity (like pain and disability scores), as it better accounts for individual variability and may enhance individualized patient assessment.

Study Population: The study analyzed 1,756 patients from the Swedish Spine Registry who underwent surgery for degenerative cervical myelopathy, with 59% reporting satisfaction at one year postoperatively.

Practical Recommendation: Incorporating MCIRC thresholds into future spine surgery outcome guidelines could improve evaluation of individualized patient recovery.

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Patient outcomes after circumferential minimally invasive surgery compared with those of open correction for adult spinal deformity

J Neurosurg Spine 36:203–214, 2022

Circumferential minimally invasive spine surgery (cMIS) for adult scoliosis has become more advanced and powerful, but direct comparison with traditional open correction using prospectively collected data is limited. The authors performed a retrospective review of prospectively collected, multicenter adult spinal deformity data. The authors directly compared cMIS for adult scoliosis with open correction in propensity-matched cohorts using health-related quality-of-life (HRQOL) measures and surgical parameters.

METHODS Data from a prospective, multicenter adult spinal deformity database were retrospectively reviewed. Inclusion criteria were age > 18 years, minimum 1-year follow-up, and one of the following characteristics: pelvic tilt (PT) > 25 , pelvic incidence minus lumbar lordosis (PI-LL) > 10 , Cobb angle > 20 , or sagittal vertical axis (SVA) > 5 cm. Patients were categorized as undergoing cMIS (percutaneous screws with minimally invasive anterior interbody fusion) or open correction (traditional open deformity correction). Propensity matching was used to create two equal groups and to control for age, BMI, preoperative PI-LL, pelvic incidence (PI), T1 pelvic angle (T1PA), SVA, PT, and number of posterior levels fused.

RESULTS A total of 154 patients (77 underwent open procedures and 77 underwent cMIS) were included after matching for age, BMI, PI-LL (mean 15  vs 17 , respectively), PI (54  vs 54 ), T1PA (21  vs 22 ), and mean number of levels fused (6.3 vs 6). Patients who underwent three-column osteotomy were excluded. Follow-up was 1 year for all patients. Postoperative Oswestry Disability Index (ODI) (p = 0.50), Scoliosis Research Society–total (p = 0.45), and EQ-5D (p = 0.33) scores were not different between cMIS and open patients. Maximum Cobb angles were similar for open and cMIS basepatients at baseline (25.9  vs 26.3 , p = 0.85) and at 1 year postoperation (15.0  vs 17.5 , p = 0.17). In total, 58.3% of open patients and 64.4% of cMIS patients (p = 0.31) reached the minimal clinically important difference (MCID) in ODI at 1 year. At 1 year, no differences were observed in terms of PI-LL (p = 0.71), SVA (p = 0.46), PT (p = 0.9), or Cobb angle (p = 0.20). Open patients had greater estimated blood loss compared with cMIS patients (1.36 L vs 0.524 L, p < 0.05) and fewer levels of interbody fusion (1.87 vs 3.46, p < 0.05), but shorter operative times (356 minutes vs 452 minutes, p = 0.003). Revision surgery rates between the two cohorts were similar (p = 0.97).

CONCLUSIONS When cMIS was compared with open adult scoliosis correction with propensity matching, HRQOL improvement, spinopelvic parameters, revision surgery rates, and proportions of patients who reached MCID were similar between cohorts. However, well-selected cMIS patients had less blood loss, comparable results, and longer operative times in comparison with open patients.

 

 

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