Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: Translation and Validation Studies of the Iranian Versions Is a Condition-Specific Instrument for Patients with Low Back Pain/Leg Symptoms Really Necessary?: The Responsiveness of the Oswestry Disability Index, MODEMS, and the SF-36 Testing minimal clinically important difference: consensus or conundrum? PROMIS PF CAT Outperforms the ODI and SF-36 Physical Function Domain in Spine Patients The MRC Spine Stabilization Trial: Surgical Methods, Outcomes, Costs, and Complications of Surgical Stabilization The Reliability of the Shuttle Walking Test, the Swiss Spinal Stenosis Questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the Assessment of Patients With Lumbar Spinal Stenosis Outcome scores in spinal surgery quantified: excellent, good, fair and poor in terms of patient-completed tools Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol Long-term results of surgery for lumbar spinal stenosis: a randomised controlled trial Determining the quality and effectiveness of surgical spine care: patient satisfaction is not a valid proxy. Outcome measures in chronic low back pain Concurrent Comparison of Responsiveness in Pain and Functional Status Measurements Used for Patients With Low Back Pain A non-randomized clinical trial to assess the impact of nonrigid, inelastic corsets on spine function in low back pain participants and asymptomatic controls. ISSLS Prize Winner: Function After Spinal Treatment, Exercise, and Rehabilitation (FASTER) A Factorial Randomized Trial to Determine Whether the Functional Outcome of Spinal Surgery Can Be Improved Comprehensive study of back and leg pain improvements after adult spinal deformity surgery: analysis of 421 patients with 2-year follow-up and of the impact of the surgery on treatment satisfaction. Literature searching for randomized controlled trials used in Cochrane reviews: rapid versus exhaustive searches. Oswestry Disability Index is a better indicator of lumbar motion than the Visual Analogue Scale. Outcomes after decompressive laminectomy for lumbar spinal stenosis: comparison between minimally invasive unilateral laminectomy for bilateral decompression and open laminectomy: clinical article. Comparison of the SF6D, the EQ5D, and the oswestry disability index in patients with chronic low back pain and degenerative disc disease Prospective analysis of clinical evaluation and self-assessment by patients after decompression surgery for degenerative lumbar canal stenosis. Transforaminal lumbar interbody fusion: a safe technique with satisfactory three to five year results MOS short form 36 and Oswestry Disability Index outcomes in lumbar fusion: a multicenter experience. Preliminary Investigation of the Mechanisms Underlying the Effects of Manipulation: Exploration of a Multivariate Model Including Spinal Stiffness, Multifidus Recruitment, and Clinical Findings Beyond Minimally Important Change: Defining a Successful Outcome of Physical Therapy for Patients With Low Back Pain Restoration of Bone Turnover Rate After Decompression Surgery in Patients With Symptomatic Lumbar Spinal Stenosis: Preliminary Report Who Should Have Surgery for Spinal Stenosis? Treatment Effect Predictors in SPORT Improvement in low back pain following spinal decompression: observational study of 119 patients Changes in Vitamin D Status After Surgery in Female Patients With Lumbar Spinal Stenosis and Its Clinical Significance Degenerative Spondylolisthesis: Does Fusion Method Influence Outcome? Four-Year Results of the Spine Patient Outcomes Research Trial Polymorphic Variation of the Guanosine Triphosphate Cyclohydrolase 1 Gene Predicts Outcome in Patients Undergoing Surgical Treatment for Lumbar Degenerative Disc Disease The efficacy of lumbar traction in the management of patients with low back pain Efficiency and Contribution of Strategies for Finding Randomized Controlled Trials: A Case Study from a Systematic Review on Therapeutic Interventions of Chronic Depression Minimum Clinically Important Difference and Substantial Clinical Benefit in Pain, Functional, and Quality of Life Scales in Failed Back Surgery Syndrome Patients Association of catechol-O-methyltransferase genetic variants with outcome in patients undergoing surgical treatment for lumbar degenerative disc disease. Effect of short-term intensive yoga program on pain, functional disability and spinal flexibility in chronic low back pain: a randomized control study. The management of thoracolumbar burst fractures: a prospective study between conservative management, traditional open spinal surgery and minimally interventional spinal surgery Lumbar supports for prevention and treatment of low back pain: a systematic review within the framework of the Cochrane Back Review Group.
BACKGROUND CONTEXT The impact of  lumbar spinal surgery  is commonly evaluated with three patient-reported outcome measures : Oswestry Disability Index ( ODI ) , the physical component summary ( PCS ) of the Short Form of the Medical Outcomes Study ( SF-36 ) , and pain scales . A minimum clinical ly important difference ( MCID ) is a threshold used to measure the effect of clinical treatments . Variable threshold values have been proposed as MCID for those instruments despite a lack of agreement on the optimal MCID calculation method . PURPOSE This study has three purpose s. First , to illustrate the range of values obtained by common anchor-based and distribution-based methods to calculate MCID . Second , to determine a statistically sound and clinical ly meaningful MCID for ODI , PCS , back pain scale , and leg pain scale in lumbar spine surgery patients . Third , to compare the discriminative ability of two anchors : a global health assessment and a rating of satisfaction with the results of the surgery . STUDY DESIGN This study is a review of prospect ively collected patient-reported outcomes data . PATIENT SAMPLE A total of 454 patients from a large data base of surgeries performed by the Lumbar Spine Study Group with a 1-year follow-up on either ODI or PCS were included in the study . OUTCOME MEASURES Preoperative and 1-year postoperative scores for ODI , PCS , back pain scale , leg pain scale , health transition item ( HTI ) of the SF-36 , and Satisfaction with Results scales . METHODS ODI , SF-36 , and pain scales were administered before and 1 year after spinal surgery . Several c and i date MCID calculation methods were applied to the data and the result ing values were compared . The HTI of the SF-36 was used as the anchor and compared with a second anchor ( Satisfaction with Results scale ) . RESULTS Potential MCID calculations yielded a range of values : fivefold for ODI , PCS , and leg pain , 10-fold for back pain . Threshold values obtained with the two anchors were very similar . CONCLUSIONS The minimum detectable change ( MDC ) appears as a statistically and clinical ly appropriate MCID value . MCID values in this sample were 12.8 points for ODI , 4.9 points for PCS , 1.2 points for back pain , and 1.6 points for leg pain Study Design . Cross-cultural translation and psychometric testing were performed . Objectives . To cross-culturally translate the Oswestry Disability Index ( ODI ) , Rol and -Morris Disability Question naire ( RDQ ) , and Quebec Back Pain Disability Scale ( QDS ) into Persian , and then investigate the psychometric properties of the Persian versions produced . Summary of Background Data . To the authors ’ knowledge , there is no vali date d instrument to measure functional status in Persian-speaking patients with low back pain ( LBP ) in Iran . To our knowledge , the widely used back-specific measures , the ODI , RDQ , and QDS , have not been translated and vali date d for Persian-speaking patients with LBP . Methods . The translation and cross-cultural adaptation of the original question naires were performed in accordance with published guidelines . A total of 100 patients with chronic LBP were asked to complete a question naire booklet ( the Persian versions of the ODI , RDQ , QDS , Short Form Health Survey ( SF-36 ) , and visual analog scale measure of pain ) . There were 31 r and omly select patients with chronic LBP asked to complete the second question naire booklet 24 hours later . Results . The Cronbach-α for the ODI , RDQ , and QDS was 0.75 , 0.83 , and 0.92 , respectively . The ODI , RDQ , and QDS showed excellent test-retest reliability ( intraclass correlation coefficient = 0.91 , 0.86 , and 0.86 , respectively ) ( P < 0.01 ) . The correlation among the ODI , RDQ , QDS and physical functioning scales of the SF-36 was −0.66 , −0.62 , and −0.69 , respectively ( P < 0.001 ) . The correlation among the ODI , RDQ , and QDS and visual analog scale was 0.54 , 0.36 , and 0.46 , respectively ( P < 0.001 ) . Conclusions . The Persian versions of the ODI , RDQ , and QDS are reliable and valid instruments to measure functional status in Persian-speaking patients with LBP.They are simple and fast scales , and the use of them can be recommended in a clinical setting and future outcome studies in Iran Study Design . Analysis of longitudinal data collected prospect ively from patients seen in 27 National Spine Network member centers across the United States . Objective . To evaluate the responsiveness of the Oswestry Disability Index , MODEMS scales , and all scales and summary scales of the MOS Short-Form 36 ( SF-36 ) for patients with low back pain/leg symptoms . Summary of Background Data . The responsiveness of general and condition-specific health status instruments is a key concept for clinicians and scientists . Various authors have explored responsiveness in common surveys used to assess spine patients . Although it is generally believed that condition-specific measures are more responsive to change in the condition under study , in the case of low back pain , most authors agree that further exploration is necessary . Methods . Patients with diagnoses of herniated disc , spinal stenosis , and spondylosis from the National Spine Network data base who completed baseline and 3-month follow-up surveys were analyzed . Patient-provider consensus regarding improvement , worsening , or no change in the condition was selected as the external criterion . Responsiveness was evaluated using ROC curve analysis and effect size calculations . Results . Nine hundred and seventy patients had complete data at baseline and 3 months . At follow-up , 68 % of the patients had consensus improvement . Based on ROC analysis , scales assessing pain were significantly more responsive than scales assessing function . There were no significant differences between the condition-specific scales and their equivalent general-health counterpart . The scales with the highest probabilities of correctly identifying patient ’s improvement were : the condition-specific pain scale from MODEMS ( PAIN , ROC = 0.758 ) ; the combined pain and function scale from MODEMS ( MPDL , ROC = 0.755 ) ; the general pain scale from the SF-36 ( BP , ROC = 0.753 ) ; the combined pain and function scale from the SF-36 ( PCS , ROC = 0.745 ) ; the condition-specific function measure from the Oswestry ( ODI , ROC = 0.723 ) ; and the physical function measure from the SF-36 ( PF , ROC = 0.721 ) . A similar rank order was typically maintained with effect size calculations . Results were nearly identical in patients with multiple non-spine-related comorbidities and in patients with high degrees of perceived  disability . The BP scale was most responsive to worsening of symptoms . Conclusion . For studies of patients with low back problems , the general SF-36 may be a sufficient measure of health status and patient function , without the need for additional condition-specific instruments .  Pain scales  appear to be the most responsive measures in patients with low back pain BACKGROUND CONTEXT Various method ologies have been used in attempting to eluci date a st and ard method for calculating minimal clinical ly important difference ( MCID ) . A consensus-based decision ( Initiative on Methods , Measurement , and Pain Assessment in Clinical Trials [ IMMPACT ] group ) suggested a 30 % reduction from baseline as a means to define the MCID of self-report back pain measures . Additionally , important psychometric issues need to be addressed regarding use of an independent measure of the same construct as an external criterion , instead of simply using another self-report measure , when using an anchor-based approach to MCID . PURPOSE The purpose was to test the validity of recently published guidelines regarding MCID using self-report back pain measures and objective socioeconomic outcomes . STUDY DESIGN / SETTING This is a prospect i ve study assessing change scores on commonly used spinal pain assessment measures in patients with chronic disabling occupational spinal disorders ( CDOSDs ) treated in a regional referral rehabilitation center performing interdisciplinary functional restoration . PATIENT SAMPLE The study consisted of consecutive cohort of patients ( N=1,180 ) with CDOSDs completing a functional restoration program . OUTCOMES MEASURES Self-report measures including the Oswestry Disability Index ( ODI ) and the physical component summary ( PCS ) and mental component summary ( MCS ) of the Short Form-36 ( SF-36 ) obtained before and after treatment , were compared with objective socioeconomically relevant outcomes obtained 1 year after treatment ( ie , work status and additional health-care utilization ) , that were the external criteria for evaluating MCID . METHODS Pre- to posttreatment improvement was calculated separately for each measure , and subjects were divided into two groups based on the change in scores relative to baseline : 30 % or greater versus less than 30 % improvement . One-year posttreatment objective socioeconomic outcomes were used as independent external criteria relevant to the CDOSD population . This population is often studied as the most costly and problematic cohort in spine care . RESULTS The ODI and SF-36 MCS were not associated with any of the objective 1-year outcomes used as external criteria . Reduced post-rehabilitation health-care utilization ( based on the percentage of patients pursuing health care from a new provider ) was weakly associated with 30 % or greater improvement on the SF-36 PCS , relative to patients whose scores changed by less than 30 % relative to baseline ( 17.0 % vs. 21.1 % ) . The same was true for the ODI and return-to-work . CONCLUSIONS When objective and independent criteria are used ( socioeconomic outcomes ) in a CDOSD cohort , the 30 % improvement in the ODI and SF-36 may not be a valid MCID index . This replicates similar conclusions made by an independent research group using a distribution-based approach to MCID . The validity of the MCID concept rests on future research using objective external criteria . Moreover , there remains a question whether the term " important " in MCID can be unequivocally and operationally defined as a reliable construct Study Design . The Oswestry Disability Index v2.0 ( ODI ) , SF36 Physical Function Domain ( SF-36 PFD ) , and PROMIS Physical Function CAT v1.2 ( PF CAT ) question naires were prospect ively collected from 1607 patients complaining of back or leg pain , visiting a university-based spine clinic . All question naires were collected electronically , using a tablet computer . Objective . The aim of this study was to compare the psychometric properties of the PROMIS PF CAT with the ODI and SF36 Physical Function Domain in the same patient population . Summary of Background Data . Evidence -based decision-making is improved by using high- quality patient-reported outcomes measures . Prior studies have revealed the shortcomings of the ODI and SF36 , commonly used in spine patients . The PROMIS Network has developed measures with excellent psychometric properties . The Physical Function domain , delivered by Computerized Adaptive Testing ( PF CAT ) , performs well in the spine patient population , though to- date direct comparisons with common measures have not been performed . Methods . St and ard Rasch analysis was performed to directly compare the psychometrics of the PF CAT , ODI , and SF36 PFD . Spearman correlations were computed to examine the correlations of the three instruments . Time required for administration was also recorded . Results . One thous and six hundred seven patients were administered all assessment s. The time required to answer all items in the PF CAT , ODI , and SF-36 PFD was 44 , 169 , and 99 seconds . The ceiling and floor effects were excellent for the PF CAT ( 0.81 % , 3.86 % ) , while the ceiling effects were marginal and floor effects quite poor for the ODI ( 6.91 % and 44.24 % ) and SF-36 PFD ( 5.97 % and 23.65 % ) . All instruments significantly correlated with each other . Conclusion . The PROMIS PF CAT outperforms the ODI and SF-36 PFD in the spine patient population and is highly correlated . It has better coverage , while taking less time to administer with fewer questions to answer . Level of Evidence : Study Design . A review of the surgical costs and results in a group of patients r and omly allocated to surgery as part of a large prospect i ve r and omized trial of patients with chronic back pain . Objective . To report the observational data from the surgical arm of a r and omized trial comparing surgery with intensive rehabilitation for chronic low back pain . Clinical and economic data are reported . Summary of Background Data . Surgery for chronic low back pain is a well established but unproven intervention . The most cost-effective technique for spinal stabilization is still not established . Methods . One hundred six patients with chronic low back pain were r and omized to the surgical group of a r and omized trial comparing spinal fusion of the lumbar with a 3 week intensive rehabilitation program . The primary outcomes were the Oswestry Disability Index ( ODI ) and the Shuttle Walking Test measured at baseline and 2 years postr and omization . Patients were stratified by preoperative diagnosis , smoking habit , and litigation . Complications were assessed and costs analyzed . Results . Of the 176 surgical patients , 56 underwent postero-lateral fusion , 57 underwent interbody fusion , and 24 underwent flexible stabilization of the spine . The mean ODI for all patients in the surgical arm of the trial improved from a baseline of 46.5 ( SD 14.6 ) to 34.2 ( SD 21 ) at 2 years . Health care costs were higher ( £ 3109 difference ) for more complex procedures , and nearly 6 times as many early complications occurred with the more complex procedures . Smoking and unemployment were associated with worse results whereas litigation did not adversely affect the outcome . Conclusion . These observational changes in the ODI after surgery are similar to those reported from other studies of spinal fusion . More complex surgery is more expensive with more complications than postero-lateral fusion Study Design . The Shuttle Walking Test ( SWT ) , the Swiss Spinal Stenosis ( SSS ) Question naire , the Oxford Claudication Score ( OCS ) , and the Oswestry Disability Index ( ODI ) were administered to patients with lumbar spinal stenosis and neurogenic claudication . Objective . To determine reliability of the SWT , the SSS ( Q1–12 ) , the OCS , and the ODI in lumbar spinal stenosis assessment . Summary of Background Data . Reliability data for exercise tests in lumbar spinal stenosis are lacking . Methods . To determine reliability , 32 clinic patients with lumbar spinal stenosis were assessed twice , with 1 week between assessment s. Retrospective data from 17 patients assessed before surgery and 18 months after surgery for lumbar spinal stenosis were used to investigate the use of reliability in a clinical setting . Results . Test – retest reliability in terms of the intraclass correlation coefficient ( ICC ) was 0.92 for the SWT , 0.92 for the SSS , 0.83 for the OCS and 0.89 for the ODI . The mean percentage scores were 51 for the SSS , 45 for the OCS , and 40 for the ODI . To achieve 95 % certainty of change between assessment s for a single patient , the SSS would need to change by 15 , the OCS by 20 , and the ODI by 16 . The mean SWT was 150 m , with a change of 76 m required for 95 % confidence . Cronbach ’s alpha was 0.91 for the SSS , 0.90 for the OCS , and 0.89 for the ODI . The change in ODI correlated most strongly with patient satisfaction after surgery ( & rgr ; = 0.80;P < 0.001 ) . Conclusions . Fluctuations in a patient ’s symptoms result in wide individual confidence intervals . Performance on the SSS , OCS , and ODI question naires are broadly similar , the most precise being the condition-specific SSS . The SWT gives a snapshot of physical function , which is acceptable for group analysis . Use of the SWT for individual assessment after surgery is feasible Outcome scores are very useful tools in the field of spinal surgery as they allow us to assess a patient ’s progress and the effect of various treatments . The clinical importance of a score change is not so clear . Although previous studies have looked at the minimum clinical ly important score change , the degree of score change varies considerably . Our study is a prospect i ve cohort study of 193 patients undergoing discectomy , decompression and fusion procedures with minimum 2-year follow-up . We have used three st and ard outcome measures in common usage , the oswestry disability index ( ODI ) , the  low back outcome score ( LBOS ) and the visual analogue score ( VAS ) . We have defined each of these scores according to a global measure of outcome grade d by the patient as excellent , good , fair or poor . We have also grade d patient perception and classified excellent and good as success and fair and poor as failure . Our results suggest that a median 24-point change in the ODI equates with a good outcome or is the minimum change needed for success . We have also found that different surgical disorders have very different minimal clinical ly important differences as perceived by patient perception . We found that for a discectomy a minimum 27-point change in the ODI would be classed as a success , for a decompression the change in ODI needed to class it as a success would be 16 points , whereas for a fusion the change in the ODI would be only 13 points . We believe that patient-rated global measures of outcome are of value and we have quantified them in terms of the st and ard outcome measures used in spinal surgery Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 We r and omised a total of 94 patients with long-st and ing moderate lumbar spinal stenosis ( LSS ) into a surgical group and a non-operative  group , with 50 and 44 patients , respectively . The operative treatment comprised undercutting laminectomy of stenotic segments , augmented with transpedicular-instrumented fusion in suspected lumbar instability . The primary outcome was the Oswestry disability index ( ODI ) , and the other main outcomes included assessment s of leg and back pain and self-reported walking ability , all based on question naire data from 85 patients at the 6-year follow-up . At the 6-year follow-up , the mean difference in ODI in favour of surgery was 9.5 ( 95 % confidence interval 0.9–18.1 , P-value for global difference 0.006 ) , whereas the intensity of leg or back pain did not differ between the two treatment groups any longer . Walking ability did not differ between the treatment groups at any time . Decompressive surgery of LSS provided modest but consistent improvement in functional ability , surpassing that obtained after non-operative measures BACKGROUND CONTEXT Given the unsustainable costs of the US health-care system , health-care purchasers , payers , and hospital systems are adopting the concept of value-based purchasing by shifting care away from low- quality providers or hospitals . Legislation now allows public reporting of these quality rankings . True measures of quality , such as surgical morbidity and vali date d question naires of effectiveness , are burdensome and costly to collect . Hence , patients ' satisfaction with care has emerged as a commonly used metric as a proxy for quality because of its feasibility of collection . However , patient satisfaction metrics have yet to be vali date d as a measure of overall quality of surgical spine care . PURPOSE We set out to determine whether patient satisfaction is a valid measure of safety and effectiveness of care in a prospect i ve longitudinal spine registry . STUDY DESIGN Prospect i ve longitudinal cohort study . PATIENT POPULATION All patients undergoing elective spine surgery for degenerative conditions over a 6-month period at a single medical center . OUTCOME MEASURES Patient-reported outcome instruments ( numeric rating scale [ NRS ] , Oswestry disability index [ ODI ] , neck disability index [ NDI ] , short-form 12-item survey [ SF-12 ] , Euro-Qol-5D [ EQ-5D ] , Zung depression scale , and Modified Somatic Perception Question naire [ MSPQ ] anxiety scale ) , return to work , patient satisfaction with outcome , and patient satisfaction with provider care . METHODS All patients undergoing elective spine surgery for degenerative conditions over a 6-month period at a single medical center were enrolled into a prospect i ve longitudinal registry . Data collected on all patients included demographics , disease characteristics , treatment variables , readmissions/reoperations , and all 90-day surgical morbidity . Patient-reported outcome instruments ( NRS , ODI , NDI , SF-12 , EQ-5D , Zung depression scale , and MSPQ anxiety scale ) , return to work , patient satisfaction with outcome , and patient satisfaction with provider care were recorded at baseline and 3 months after treatment . Receiver-operating characteristic ( ROC ) curve analysis was performed to determine whether extent of improvement in quality of life ( SF-12 physical component summary [ PCS ] ) and disability ( ODI/NDI ) accurately predicted patient satisfaction versus dissatisfaction . St and ard interpretation of area under the curve ( AUC ) was used : less than 0.7 , poor ; 0.7 to 0.8 , fair ; and greater than 0.8 , good accuracy . Multivariate logistic regression analysis was performed to determine if surgical morbidity ( quality ) or improvement in disability and quality of life ( effectiveness of care ) were independently associated with patient satisfaction . RESULTS Four hundred twenty-two ( 84 % ) patients completed all question naires 3 months after surgery during the review ed time period ( mean age 55±14 years ) . Lumbar surgery was performed in 287 ( 68 % ) and cervical surgery in 135 ( 32 % ) patients . There were 51 ( 12.1 % ) 90-day complications , including 21 ( 5.0 % ) readmissions and 12 ( 2.8 % ) return to operating room . Three hundred fifty-eight ( 84.8 % ) patients were satisfied with provider care and 288 ( 68.2 % ) with their outcome . Satisfaction with provider care : In ROC analyses , extent of improvement in quality of life ( SF-12 ) and disability ( ODI/NDI ) differentiated satisfaction versus dissatisfaction with care with very poor accuracy ( AUC 0.49 - 0.69 ) . In regression analysis , 3-month morbidity ( odds ratio [ 95 % confidence interval ] : 1.45 [ 0.79 - 2.66 ] ) , readmission ( 0.66 [ 0.24 - 1.80 ] ) , improvement in quality of life ( SF-12 PCS ) , or improvement in general health ( health transition index ) were not associated with satisfaction with care . Satisfaction with outcome : In ROC analyses , improvement in quality of life ( SF-12 ) and disability ( ODI/NDI ) failed to differentiate satisfaction with good accuracy ( AUC 0.76 ) . Neither 90-day morbidity ( 1.05 [ 0.46 - 2.34 ] ) nor 90-day readmission ( 0.27 [ 0.04 - 2.04 ] ) was associated with satisfaction with outcome in regression analysis . CONCLUSIONS Patient satisfaction is not a valid measure of overall quality or effectiveness of surgical spine care . Patient satisfaction metrics likely represent the patient 's subjective contentment with health-care service , a distinct aspect of care . Satisfaction metrics are important patient-centered measures of health-care service but should not be used as a proxy for overall quality , safety , or effectiveness of surgical spine care The purpose of this prospect i ve , single site cohort quasi-experimental study was to determine the responsiveness of the numerical rating scale ( NRS ) , Rol and –Morris disability question naire ( RMDQ ) , Oswestry disability index ( ODI ) , pain self-efficacy question naire ( PSEQ ) and the patient-specific functional scale ( PSFS ) in order to determine which would best measure clinical ly meaningful change in a chronic low back pain ( LBP ) population . Several patient-based outcome instruments are currently used to measure treatment effect in the chronic LBP population . However , there is a lack of consensus on what constitutes a “ successful ” outcome , how an important improvement/deterioration has been defined and which outcome measure(s ) best captures the effectiveness of therapeutic interventions for the chronic LBP population . Sixty-three consecutive patients with chronic LBP referred to a back exercise and education class participated in this study ; 48 of the 63 patients had complete data . Five question naires were administered initially and after the 5-week back class intervention . Also at 5 weeks , patients completed a global impression of change as a reflection of meaningful change in patient status . Score changes in the five different question naires were subjected to both distribution- and anchor-based methods : st and ard error of measurement ( SEM ) and receiver operating characteristic ( ROC ) curves to define clinical improvement . From these methods , the minimal clinical ly important difference ( MCID ) defined as the smallest difference that patients and clinicians perceive to be worthwhile is presented for each instrument . Based on the SEM , a point score change of 2.4 in the NRS , 5 in the RMDQ , 17 in the ODI , 11 on the PSEQ , and 1.4 on the PSFS corresponded to the MCID . Based on ROC curve analysis , a point score change of 4 points for both the NRS and RMDQ , 8 points for the ODI , 9 points for the PSEQ and 2 points for the PSFS corresponded to the MCID . The ROC analysis demonstrated that both the PSEQ and PSFS are responsive to clinical ly important change over time . The NRS was found to be least responsive . The exact value of the MCID is not a fixed value and is dependent on the assessment method used to calculate the score change . Based on ROC curve analysis the PSFS and PSEQ were more responsive than the other scales in measuring change in patients with chronic LBP following participation in a back class programme . However , due to the small sample size , the lack of observed worsening of symptoms over time , the single centre and intervention studied these results which need to be interpreted with caution Study Design . Prospect i ve study of two sample s of patients with acute and chronic low back pain , respectively . Objectives . To compare the responsiveness of four functional status question naires , Rol and Morris Disability Question naire ( RMDQ ) ,  Oswestry Disability Index ( ODI ) ,  Disability Rating Index ( DRI ) , and  Physical Functioning scale of the SF-36 ( PFSF-36 ) , and two  pain scales , a  Numerical Pain Rating Scale ( NRS ) and  Visual Analogue Scale ( VAS ) .  Summary of Background Data . Concurrent comparisons of different outcome measurements in back patients have been requested . Methods .  Norwegian versions of the scales and question naires  were completed by 54 patients with acute ( < 3weeks ) and 50 patients with chronic low back pain ( > 3 months ) . Clinical change was estimated on a global change index . An alternative external criterion was the expected clinical course in the two cohorts . Mean changes , st and ardized response mean ( SRM ) , and area under the receiver operating characteristic ( ROC ) curves with cutoff point for highest sensitivity and specificity were calculated . Results . At the follow-up , 63 % of the acute and 41 % of the chronic sample reported improvement on the global change index . Large SRMs ( 1.3–2.0 ) and areas under the ROC curves ( 0.84–0.93 ) were found for the measurements in the acute sample . In the chronic sample , the SRMs ( 0.4–1.1 ) and areas under the ROC curves ( 0.65–0.83 ) were lower , in particular for the PFSF-36 and the VAS . There was no statistically significant difference between the responsiveness in the measurements , except for higher responsiveness in the NRS compared with the VAS when using expected clinical course as the external criterion for change . Conclusion . The results suggest that all the outcome measures were appropriate for measuring changes in functional status and pain in patients with acute low back pain , whereas among chronic patients the RMDQ , ODI , DRI , and NRS were most appropriate BACKGROUND CONTEXT Although previous studies suggest braces/corsets can reduce acute pain , no prior study has assessed back function after bracing with both self-reported and objective measures . Use of both self-reported and objective measures of spine function together may be important given evidence they assess unique aspects of function . PURPOSE The aim was to assess both self-reported and objective measures of spinal function before , and after , use of a nonrigid , inelastic lumbar brace . STUDY DESIGN / SETTING This was a non-r and omized clinical trial . PATIENT SAMPLE The sample included acute low back pain ( LBP ) participants and asymptomatic controls . OUTCOME MEASURES Oswestry Disability Index ( ODI ) , spinal stiffness , and muscle endurance were the outcome measures . METHODS Three groups were studied : -LBP/-Brace ( n=19 ) , -LBP/+Brace ( n=18 ) , and + LBP/+Brace ( n=17 ) . Both groups of braced participants were instructed to wear the brace continually for 2 weeks with the exception of bedroom and bathroom activities . Before and after the 2-week period , three measures of spinal function were performed : spinal stiffness via motorized indentation of the L3 spinous process , a modified Sorensen test ( timed lumbar extension against gravity ) , and the ODI . Repeated measures analyses of variance were conducted for all three outcomes . RESULTS Among the groups , ODI scores decreased significantly for the + LBP/+Brace group ( p<.001 ) compared with the other two groups . The + LBP/+Brace mean ODI score decreased 3.71 points ( 95 % confidence interval [ CI ] 2.01 - 5.40 ) compared with the -LBP/-Brace group and decreased 3.48 points ( 95 % CI 1.77 - 5.20 ) compared with the -LBP/+Brace group . Change scores for the Sorensen test were significantly increased in the + LBP/+Brace group ( p=.037 ) compared with the -LBP/-Brace group ( 22.47s 95 % CI 8.14 - 36.80 ) . Spinal stiffness did not change significantly between groups . CONCLUSIONS This study demonstrates that lumbar function assessed by self-reported and objective measures does not worsen when nonrigid , inelastic bracing is used for short periods of time for those with , or without , back pain . These data add to the existing literature that suggests short-term use of nonrigid , inelastic bracing for acute LBP does not decrease spinal function when measured separately with subjective or objective tools Study Design . This was a multicenter , factorial , r and omized , controlled trial on the postoperative management of spinal surgery patients , with r and omization stratified by surgeon and operative procedure . Objective . This study sought to determine whether the functional outcome of two common spinal operations could be improved by a program of postoperative rehabilitation that combines professional support and advice with grade d active exercise commencing 6 weeks after surgery and /or an educational booklet based on evidence -based messages and advice received at discharge from hospital , each compared with usual care . Summary of Background Data . Surgical interventions on the spine are increasing , and while surgery for spinal stenosis and disc prolapse have been shown to be superior to conservative management , functional outcome , and patient satisfaction are not optimal . Methods . The study compared the effectiveness of a rehabilitation program and an education booklet for the postoperative management of patients undergoing discectomy or lateral nerve root decompression surgery , each compared with “ usual care ” using a 2 × 2 factorial design , r and omizing patient to four groups ; rehabilitation-only , booklet-only  , rehabilitation-plus-booklet , and usual care only . The primary outcome measure was the Oswestry Disability Index ( ODI ) at 12 months , with secondary outcomes including visual analog scale measures of back and leg pain . Results . Three hundred thirty-eight patients were recruited into the study and measurements were obtained preoperatively and then repeated at 6 weeks , 3 , 6 , 9 and 12 months postoperatively . Twelve months postoperatively the observed effect of rehabilitation  on ODI was −2.7 ( 95 % CI : −6.8 to 1.5 ) and the effect of booklet was 2.7 ( 95 % CI : −1.5 to 6.9 ) . Conclusion . This study found that neither intervention had a significant impact on long-term outcome OBJECT Back and leg pain are the primary outcomes of adult spinal deformity ( ASD ) and predict patients ' seeking of surgical management . The authors sought to characterize changes in back and leg pain after operative or nonoperative management of ASD . Outcomes were assessed according to pain severity , type of surgical procedure , Scoliosis Research Society (SRS)-Schwab spine deformity class , and patient satisfaction . METHODS This study retrospectively review ed data in a prospect i ve multicenter data base of ASD patients . Inclusion criteria were the following : age > 18 years and presence of spinal deformity as defined by a scoliosis Cobb angle ≥ 20 ° , sagittal vertical axis length ≥ 5 cm , pelvic tilt angle ≥ 25 ° , or thoracic kyphosis angle ≥ 60 ° . Patients were grouped into nonoperated and operated subcohorts and by the type of surgical procedure , spine SRS-Schwab deformity class , preoperative pain severity , and patient satisfaction . Numerical rating scale ( NRS ) scores of back and leg pain , Oswestry Disability Index ( ODI ) scores , physical component summary ( PCS ) scores of the 36-Item Short Form Health Survey , minimum clinical ly important differences ( MCIDs ) , and substantial clinical benefits ( SCBs ) were assessed . RESULTS Patients in whom ASD had been operatively managed were 6 times more likely to have an improvement in back pain and 3 times more likely to have an improvement in leg pain than patients in whom ASD had been nonoperatively managed . Patients whose ASD had been managed nonoperatively were more likely to have their back or leg pain remain the same or worsen . The incidence of postoperative leg pain was 37.0 % at 6 weeks postoperatively and 33.3 % at the 2-year follow-up ( FU ) . At the 2-year FU , among patients with any preoperative back or leg pain , 24.3 % and 37.8 % were free of back and leg pain , respectively , and among patients with severe ( NRS scores of 7 - 10 ) preoperative back or leg pain , 21.0 % and 32.8 % were free of back and leg pain , respectively . Decompression result ed in more patients having an improvement in leg pain and their pain scores reaching MCID . Although osteotomies improved back pain , they were associated with a higher incidence of leg pain . Patients whose spine had an SRS-Schwab coronal curve Type N deformity ( sagittal malalignment only ) were least likely to report improvements in back pain . Patients with a Type L deformity were most likely to report improved back or leg pain and to have reductions in pain severity scores reaching MCID and SCB . Patients with a Type D deformity were least likely to report improved leg pain and were more likely to experience a worsening of leg pain . Preoperative pain severity affected pain improvement over 2 years because patients who had higher preoperative pain severity experienced larger improvements , and their changes in pain severity were more likely to reach MCID/SCB than for those reporting lower preoperative pain . Reductions in back pain contributed to improvements in ODI and PCS scores and to patient satisfaction more than reductions in leg pain did . CONCLUSIONS The authors ' results provide a valuable reference for counseling patients preoperatively about what improvements or worsening in back or leg pain they may experience after surgical intervention for ASD OBJECTIVES To analyze sources search ed in Cochrane review s , to determine the proportion of trials included in review s that are indexed in major data bases , and to compare the quality of these trials with those from other sources . METHODS All new systematic review s in the Cochrane Library , Issue1 2001 , that were restricted to r and omized controlled trials ( RCTs ) or quasi- RCTs were selected . The sources search ed in the review s were recorded , and the trials included were checked to see whether they were indexed in four major data bases . Trials not indexed were checked to determine how they could be identified . The quality of trials found in major data bases was compared with those found from other sources . RESULTS The range in the number of data bases search ed per review ranged between one and twenty-seven . The proportion of the trials in the four data bases were Cochrane Controlled Trials Register = 78.5 % , MEDLINE = 68.8 % , Embase = 65.0 % , and Science/Social Sciences Citation Index = 60.7 % . Search ing another twenty-six data bases after Cochrane Controlled Trials Register ( CCTR ) , MEDLINE , and Embase only found 2.4 % additional trials . There was no significant difference between trials found in the CCTR , MEDLINE , and Embase compared with other trials , with respect to adequate allocation concealment or sample size . CONCLUSIONS There was a large variation between review s in the exhaustiveness of the literature search es . CCTR was the single best source of RCTs . Additional data base search ing retrieved only a small percentage of extra trials . Contacting authors and manufacturers to find unpublished trials appeared to be a more effective method of obtaining the additional better quality trials BACKGROUND CONTEXT Lumbar pathology is often associated with axial pain or neurologic complaints . It is often presumed that such pain is associated with decreased lumbar motion ; however , this correlation is not well established . The utility of various outcome measures that are used in both research and clinical practice have been studied , but the connection with range of motion ( ROM ) has not been well documented . PURPOSE The current study was performed to assess objective ly the postulated correlation of lumbar complaints ( based on st and ardized outcome measures ) with extremes of lumbar ROM and functional ROM ( fROM ) with activities of daily living ( ADLs ) as assessed with an electrogoniometer . STUDY DESIGN / SETTING This study was a clinical cohort study . PATIENT SAMPLE Subjects slated to undergo a lumbar intervention ( injection , decompression , and /or fusion ) were enrolled voluntarily in the study . OUTCOME MEASURES The two outcome measures used in the study were the Visual Analogue Scale ( VAS ) for axial extremity , lower extremity , and combined axial and lower extremity , as well as the Oswestry Disability Index ( ODI ) . METHODS Pain and disability scores were assessed with the  VAS score and ODI . A previously vali date d electrogoniometer was used to measure ROM ( extremes of motion in three planes ) and fROM ( functional motion during 15 simulated activities of daily living ) . Pain and disability scores were analyzed for statistically significant association with the motion assessment s using linear regression analyses . RESULTS Twenty-eight men and 39 women were enrolled , with an average age of 55.6 years ( range , 18 - 79 years ) . The ODI and VAS were associated positively ( p<.001 ) . Combined axial and lower extremity VAS scores were associated with lateral and rotational ROM ( p<.05 ) , but not with flexion/extension or any fROM . Similar findings were noted for separately analyzed axial and lower extremity VAS scores . On the other h and , the ODI correlated inversely with ROM in all planes , and fROM in at least one plane for 10 of 15 ADLs ( p<.05 ) . CONCLUSIONS Extremes of lumbar motion and motions associated with ADLs are of increasing clinical interest . Although the ODI and VAS are associated with each other , the ODI appears to be a better predictor of these motion parameters than the VAS ( axial extremity , lower extremity , or combined ) and may be more useful in the clinical setting when considering functional movement parameters OBJECT The development of minimally invasive surgical techniques is driven by the quest for better patient outcomes . There is some evidence for the use of minimally invasive surgery for degenerative lumbar spine stenosis ( LSS ) , but there are currently no studies comparing outcomes with matched controls . The object of this study was to compare outcomes following minimally invasive unilateral laminectomy for bilateral decompression ( ULBD ) to a st and ard " open " laminectomy for LSS . METHODS The authors conducted a prospect i ve , 1:1 r and omized trial comparing ULBD to open laminectomy for degenerative LSS . The study enrolled 79 patients between 2007 and 2009 , and adequate data for analysis were available in 54 patients ( 27 in each arm of the study ) . Patient demographic characteristics and clinical characteristics were recorded and clinical outcomes were obtained using pre- and postoperative Oswestry Disability Index ( ODI ) scores , visual analog scale ( VAS ) scores for leg pain , patient satisfaction index scores , and postoperative 12-Item Short Form Health Survey ( SF-12 ) scores . RESULTS Significant improvements were observed in ODI and VAS scores for both open and ULBD interventions ( p < 0.001 for both groups using either score ) . In addition , the ULBD-treated patients had a significantly better mean improvement in the VAS scores ( p = 0.013 ) but not the ODI scores ( p = 0.055 ) compared with patients in the open-surgery group . ULBD-treated patients had a significantly shorter length of postoperative hospital stay ( 55.1 vs. 100.8 hours , p = 0.0041 ) and time to mobilization ( 15.6 vs. 33.3 hours , p < 0.001 ) and were more likely to not use opioids for postoperative pain ( 51.9 % vs. 15.4 % , p = 0.046 ) . CONCLUSIONS Based on short-term follow-up , microscopic ULBD is as effective as open decompression in improving function ( ODI score ) , with the additional benefits of a significantly greater decrease in pain ( VAS score ) , postoperative recovery time , time to mobilization , and opioid use Background The need for cost effectiveness analyses in r and omized controlled trials that compare treatment options is increasing . The selection of the optimal utility measure is important , and a central question is whether the two most commonly used indexes - the EuroQuol 5D ( EQ5D ) and the Short Form 6D ( SF6D ) – can be used interchangeably . The aim of the present study was to compare change scores of the EQ5D and SF6D utility indexes in terms of some important measurement properties . The psychometric properties of the two utility indexes were compared to a disease-specific instrument , the Oswestry Disability Index ( ODI ) , in the setting of a r and omized controlled trial for degenerative disc disease . Methods In a r and omized controlled multicentre trial , 172 patients who had experienced low back pain for an average of 6 years were r and omized to either treatment with an intensive back rehabilitation program or surgery to insert disc prostheses .  Patients filled out the ODI , EQ5D , and SF-36 at baseline and two-year follow up . The utility indexes was compared with respect to measurement error , structural validity , criterion validity , responsiveness , and interpretability according to the COSMIN taxonomy . Results At follow up , 113 patients had change score values  for all three instruments . The SF6D had better similarity with the disease-specific instrument ( ODI ) regarding sensitivity , specificity , and responsiveness . Measurement error was lower for the SF6D ( 0.056 ) compared to the EQ5D ( 0.155 ) . The minimal important change score value was 0.031 for SF6D and 0.173 for EQ5D . The minimal detectable change score value at a 95 % confidence level were 0.157 for SF6D and 0.429 for EQ5D , and the difference in mean change score values ( SD ) between them was 0.23 ( 0.29 ) and so exceeded the clinical significant change score value for both instruments . Analysis of psychometric properties indicated that the indexes are unidimensional when considered separately , but that they do not exactly measure the same underlying construct . Conclusions This study indicates that the difference in important measurement properties between EQ5D and SF6D is too large to consider them interchangeable . Since the similarity with the “ gold st and ard ” ( the disease-specific instrument ) was quite different , this could indicate that the choice of index should be determined by the diagnosis BACKGROUND CONTEXT Objective measures including neurological findings , radiographic evaluation , and the Japanese Orthopaedic Association ( JOA ) score are commonly used for the evaluation of surgical outcomes . Because many surgeries are performed primarily to improve quality of life , a patient 's subjective evaluations are also important for accurately assessing surgical outcomes . Currently available instruments for assessing quality of life include the Short-Form 36 ( F-36 ) , the Oswestry disability index ( ODI ) , and the visual analog scale ( VAS ) clinical pain scale . PURPOSE The aims of this study were to measure surgical outcomes by using both objective measures and subjective measures including patient self- assessment s and psychological changes ; to assess the adequacy of the JOA alone for measuring outcome ; and to determine which measures , the SF-36v2 , ODI , VAS , or JOA correlate with the VAS pain scale score in lumbar canal stenosis . STUDY DESIGN We performed a prospect i ve study to measure surgical outcomes for lumbar canal stenosis using traditional objective measures such as neurological findings and subjective measures such as performance of ADLs , patient self- assessment s , and psychological changes . PATIENT SAMPLE Forty-two surgical patients with a mean age of 66.8+/-10.9 years at the time of surgery were included in the study . All cases were followed for more than 2 years . Surgical indications included no response to conservative treatment and neurological deterioration . Neurological symptoms were classified as nerve root type , cauda equine type , or combined type . We performed surgical decompression at the location of the dural or root indentation by myelography . The concomitant diagnosis causing the spinal stenosis was degenerative spondylolisthesis in 20 cases undergoing posterolateral fusion with pedicle screws . OUTCOME MEASURES Surgical outcomes were assessed by comparing preoperative and 24-month postoperative JOA scores for low back pain , SF-36v2 , ODI-v2 , and VAS scores . Statistical analysis was performed by using the analysis of variance . A p value<0.05 was considered statistically significant . METHODS Objective clinical measures , patient self- assessment s , and psychological changes were measured before and at 24 months postoperatively . We also examined which measurements correlated with the VAS scale for pain evaluation , thereby relating patient satisfaction to surgery outcome . RESULTS All JOA , SF-36v2 , ODI-v2 , and VAS scores significantly improved postoperatively . The physical component summary ( PCS ) of the SF-36 v2 showed significant improvement , although all scores remained less than the Japanese norm-based scores ( NBSs ) . The mental component summary ( MCS ) exhibited such a significant improvement that all postoperative subscales were higher than the Japanese NBS . JOA scores significantly correlated only with postoperative lower-extremity VAS score . All PCS and two MCS scores significantly correlated with the VAS score for low back pain . Parts of the PCS and MCS significantly correlated with the lower-extremity VAS . The ODI significantly correlated with both the preoperative and postoperative VAS scores for low back pain as well as with the postoperative lower-extremity VAS score . CONCLUSIONS The JOA , SF-36 , ODI , and VAS question naires are all useful instruments for measuring surgical outcomes . The VAS score is a better assessment of physical rather than mental health . The ODI is more reflective of patients ' subjective symptoms . Finally , the SF-36 is particularly informative because it includes questions addressing both psychological and physical status . Therefore , when combined , the SF-36v2 , VAS , and ODI scores are a valuable complement to the JOA scores in evaluating outcomes of surgery for lumbar canal stenosis The unilateral transforaminal approach for lumbar interbody fusion as an alternative to the anterior ( ALIF ) and traditional posterior lumbar interbody fusion ( PLIF ) combined with pedicle screw instrumentation is gaining in popularity . At present , a prospect i ve study using a st and ardized tool for outcome measurement after the transforaminal lumber interbody fusion ( TLIF ) with a follow-up of at least 3 years is not available in the current literature , although there have been reports on specific complications and cost efficiency . Therefore , a study of TLIF was undertaken . Fifty-two consecutive patients with a minimum follow-up of 3 years were included , with the mean follow-up being 46 months ( 36–64 ) . The indications were 22 isthmic spondylolistheses and 30 degenerative disorders of the lumbar spine . Thirty-nine cases were one-level , 11 cases were two-level , and two cases were three-level fusions .  The pain and disability status was prospect ively evaluated by the Oswestry disability index ( ODI ) and a visual analog scale ( VAS ) . The status of bony fusion was evaluated by an independent radiologist using anterior – posterior and lateral radiographs . The operation time averaged 173 min for one-level and 238 min for multiple-level fusions . Average blood loss was 485 ml for one-level and 560 ml for multiple-level fusions . There were four serious complications registered : a deep infection , a persistent radiculopathy , a symptomatic contralateral disc herniation and a pseudarthrosis with loosening of the implants . Overall , the pain relief in the VAS and the reduction of the ODI was significant ( P<0.05 ) at follow-up . The fusion rate was 89 % . At the latest follow-up , significant differences of the ODI were neither found between isthmic spondylolistheses and degenerative diseases , nor between one- and multiple-level fusions . In conclusion , the TLIF technique has comparable results to other interbody fusions , such as the PLIF and ALIF techniques . The potential advantages of the TLIF technique include avoidance of the anterior approach and reduction of the approach related posterior trauma to the spinal canal BACKGROUND CONTEXT Patient-based quality of life scales have become a critical element of post-op assessment for lumbar fusion surgery . The most extensive outcomes data have been generated through FDA -regulated IDE trials for new technologies , which produce excellent data but are constrained by strict enrollment criteria and limited indications . This raises a question as to whether the excellent results seen in these IDE trials can be reproduced in st and ard clinical practice . PURPOSE The purpose of this study was to analyze surgical results based upon st and ardized outcome tools , across a spectrum of interventions , for one- and two-level lumbar spine fusion procedures . DESIGN / SETTING This study is a retrospective review of prospect ively collected patient based outcomes data . PATIENT SAMPLE Four hundred ninety-seven patients , who underwent 1- or 2-level lumbar spine fusion at five participating spine centers , utilizing a variety of surgical techniques . Enrollment criteria included available demographic , surgical and clinical outcome data . At a minimum , patients had pre-op and one year post-op SF-36 data . In many cases two-year post-op SF-36 data and concomitant Oswestry Disability Index ( ODI ) data was available . OUTCOME MEASURES SF36 and ODI . METHODS The patient population included 270 females and 227 males , with a mean age of 47 years . Sixty-five percent ( N=324 ) had one level fusions and 35 % ( N=173 ) had two level fusions . Demographic data collected included age , gender , BMI , surgical history , smoking history and work status . Data was analyzed with repeated measures analysis of variance ( ANOVA ) . RESULTS SF-36 Physical Composite Score ( PCS ) improved a mean 9.9 points at one year post-op and 9.5 points at two years post-op . ODI improved a mean 22.2 points at one year post-op and 22.1 points at two years post-op . SF-36 PCS data for surgical approach subgroups revealed greater improvement ( p=.03 ) in the ALIF group as compared to the PSF , PLIF/TLIF , or 360 degrees fusion groups ( 12.6 points vs. 8.8 , 9.3 , 8.4 points ) at 1 year post-op . At 2 years post-op , there was greater improvement ( p=.02 ) in the ALIF and PSF groups as compared to the PLIF/TLIF and 360 degrees fusion groups ( 13.8 and 11.2 points vs. 7.7 and 6.3 points ) . SF-36 PCS data demonstrated similar baseline scores for patients with and without prior decompression , but a significantly greater rate of improvement ( 11.3 vs. 7.2 points , p=.002 ) for patients without prior lumbar decompression surgery . The ODI data indicated a significantly greater disability at baseline in the prior decompression group , with greater improvement ( 21.7 vs. 17.5 points ) in patients without prior surgery . CONCLUSIONS This study documents improved outcomes , based on SF-36 and ODI scores , in patients undergoing lumbar fusion for one and two level degenerative disc disease . The findings also demonstrate efficacy for all of the surgical techniques studied , suggesting that surgeons can appropriately select the surgical strategy with which they are most adept Study Design . Prospect i ve case series . Objective . To examine spinal stiffness in patients with low back pain ( LBP ) receiving spinal manipulative therapy ( SMT )  , evaluate associations between stiffness characteristics and clinical outcome , and explore a multivariate model of SMT mechanisms as related to effects on stiffness , lumbar multifidus ( LM ) recruitment , and status on a  clinical prediction rule  ( CPR ) for SMT outcomes . Summary of Background Data . Mechanisms underlying the clinical effects of SMT are poorly understood . Many explanations have been proposed , but few studies have related potential mechanisms to clinical outcomes or considered multiple mechanisms concurrently . Methods . Patients with LBP were treated with two SMT sessions over 1 week . CPR status was assessed at baseline . Clinical outcome was based on the Oswestry disability index ( ODI ) . Mechanized indentation measures of spinal stiffness and ultrasonic measures of LM recruitment were taken before and after each SMT , and after 1 week . Global and terminal stiffness were calculated . Multivariate regression was used to evaluate the relationship between stiffness variables and percentage ODI improvement . Zero-order correlations among stiffness variables , LM recruitment changes , CPR status , and clinical outcome were examined . A path analysis was used to evaluate a multivariate model of SMT effects . Results . Forty-eight patients ( 54 % women ) had complete stiffness data . Significant immediate decreases in global and terminal stiffness occurred post-SMT regardless of outcome . ODI improvement was related to greater immediate decrease in global stiffness ( P = 0.025 ) , and less initial terminal stiffness ( P = 0.01 ) . Zero-order correlations and path analysis supported a multivariate model suggesting that clinical outcome of SMT is mediated by improvements in LM recruitment and immediate decrease in global stiffness . Initial terminal stiffness and CPR status may relate to outcome though their relationship with LM recruitment . Conclusion . The underlying mechanisms explaining the benefits of SMT appear to be multifactorial . Both spinal stiffness characteristics and LM recruitment changes appear to play a role Study Design . Prospect i ve , longitudinal cohort study Objective . To examine the validity of a threshold that has been used to define a successful outcome for patients with low back pain ( LBP ) , undergoing nonsurgical rehabilitation based on a 50 % improvement on the Modified Oswestry disability index ( ODI ) .  Summary of Background Data . Making research findings interpretable is a goal of evidence -based practice . One attempt to improve interpretability is reporting treatment results as the percentage of patients achieving a threshold level of improvement within treatment groups along with mean between-group differences . The most recommended threshold is the minimum clinical ly important difference of the outcome tool . For clinical conditions with favorable natural histories such as LBP , thresholds requiring more than minimal improvement may be preferable for defining success . Methods . Patients with LBP receiving 4 weeks of physical therapy  were examined . The ODI and measures of pain , fear-avoidance beliefs , and demographic characteristics were recorded at baseline and after treatment . A 15-point global rating of change was also completed after treatment . The percent ODI change with treatment was computed and compared between groups known to have different prognoses . The percent ODI change was compared to the global rating of change to determine the accuracy of various thresholds of success based on the percent ODI change . Results . A total of 243 subjects ( mean age 37.2 ± 11.4 years , 44.9 % female ) were included . Mean percent ODI change was 43.1 % ( ±40.5 ) , and 109 subjects ( 44.9 % ) had a successful outcome ( ≥50 % ODI improvement ) . As hypothesized , baseline factors with known prognostic importance were less likely to be present in subjects with a successful outcome . The 50 % ODI improvement threshold for success had high sensitivity ( 0.84 ; 95 % CI : 0.79 , 0.88 ) and specificity ( 0.89 ; 95 % CI : 0.85 , 0.93 ) when compared with success based on the global rating of change . No other percent improvement threshold for the ODI had a higher accuracy than the 50 % threshold when compared to the global rating of change . Conclusion . A threshold of 50 % improvement on the ODI may be a valid measure for defining a successful outcome for patients with LBP Study Design . Prospect i ve short-term longitudinal study . Objective . To investigate changes in the bone turnover rate in patients with lumbar spinal stenosis ( LSS ) before and after decompression surgery . Summary of Back ground Data . Decompression surgery enables elderly patients with LSS to participate in daily activities and physical exercise by reducing or alleviating leg and back pain . However , there have been no studies to date regarding the effect of decompression surgery on bone metabolism in such patients . Methods . Twenty-three patients with spinal stenosis who were scheduled to undergo decompression surgery were enrolled in our study . Ten patients were given oral bisphosphonates after the operation ( B+ group ) , while the remaining 13 patients did not receive oral bisphosphonate ( B− group ) . In both groups , walking distance without rest , the Oswestry Disability Index ( ODI ) scores , duration of symptoms , bone formation , and resorption markers , and bone mineral density were recorded before surgery . Three months after surgery , bone turnover markers , a single trial for walking distance without rest and ODI scores were measured for both groups . Results . Three months after the operation , the bone resorption marker u-NTx was decreased significantly for both groups . Although there was a decrease in bALP , a bone formation maker , in both groups , the change in each group was not statistical significant . Distance in a single trial walk was increased and ODI scores were decreased significantly for both groups . Conclusion . This study suggests that decompression surgery has a beneficial effect on bone metabolism in patients with LSS who have walking intolerance and limited physical activity Study Design . Combined prospect i ve r and omized controlled trial and observational cohort study of spinal stenosis ( SpS ) with an as-treated analysis . Objective . To determine modifiers of the treatment effect ( TE ) of  surgery  ( the difference between surgical and nonoperative outcomes ) for SpS using subgroup analysis . Summary of Background Data . The Spine Patient Outcomes Research Trial demonstrated a positive surgical TE for SpS at the group level . However , individual characteristics may affect TE . No previous studies have evaluated TE modifiers in SpS. Methods . SpS patients were treated with either surgery ( n = 419 ) or nonoperative care ( n = 235 ) and were analyzed according to treatment received . Fifty-three baseline variables were used to define subgroups for calculating the time-weighted average TE for the Oswestry Disability Index ( ODI ) over 4 years ( TE = & Dgr;ODIsurgery – & Dgr;ODInonoperative ) . Variables with significant subgroup × treatment interactions ( P < 0.05 ) were simultaneously entered into a multivariate model to select independent TE predictors . Results . Other than smokers , all analyzed subgroups including at least 50 patients improved significantly more with surgery than with nonoperative treatment ( P < 0.05 ) . Multivariate analysis demonstrated : baseline ODI ⩽ 56 ( TE −15.0 vs. −4.4 , ODI > 56 , P < 0.001 ) , not smoking ( TE −11.7 vs. −1.6 smokers , P < 0.001 ) , neuroforaminal stenosis ( TE −14.2 vs. −8.7 no neuroforaminal stenosis , P = 0.002 ) , predominant leg pain ( TE −11.5 vs. −7.3 predominant back pain , P = 0.035 ) , not lifting at work ( TE −12.5 vs. −0.5 lifting at work , P = 0.017 ) , and the presence of a neurological deficit ( TE −13.3 vs. −7.2 no neurological deficit , P < 0.001 ) were associated with greater TE . Conclusion . With the exception of smokers , patients who met strict inclusion criteria improved more with surgery than with nonoperative treatment , regardless of other specific characteristics . However , TE varied significantly across certain subgroups , and these data can be used to individualize shared decision making discussion s about likely outcomes . Smoking cessation should be considered before surgery for Abstract Study design Prospect i ve clinical observational study of low back pain ( LBP ) in patients undergoing laminectomy or laminotomy surgery for lumbar spinal stenosis ( LSS ) . Objectives To quantify any change in LBP following laminectomy or laminotomy spinal decompression surgery . Patients and methods 119 patients with LSS completed Oswestry Disability Index question naire ( ODI ) and Visual Analogue Scale for back and leg pain , preoperatively , 6 weeks and 1 year postoperatively . Results There was significant ( p < 0.0001 ) reduction in mean LBP from a baseline of 5.14/10 to 3.03/10 at 6 weeks . Similar results were seen at 1 year where mean LBP score was 3.07/10 . There was a significant ( p < 0.0001 ) reduction in the mean ODI at 6 weeks and 1 year postoperatively . Mean ODI fell from 44.82 to 25.13 at 6 weeks and 28.39 at 1 year . Conclusion The aim of surgery in patients with LSS is to improve the result ing symptoms that include radicular leg pain and claudication . This observational study reports statistically significant improvement of LBP after LSS surgery . This provides frequency distribution data , which can be used to inform prospect i ve patients of the expected outcomes of such surgery Study Design . A prospect i ve cohort study . Objective . To demonstrate the changes in vitamin D status after surgery in female patients with lumbar spinal stenosis ( LSS ) , and its correlation with surgical outcomes . Summary of Background Data . In patients with LSS , general health including walking ability and nutritional status can be markedly improved by decompressive surgery . It can be hypothesized that such improvement may have a positive effect on their vitamin D status . Methods . In total , 31 female patients who underwent decompression and instrumented posterolateral fusion for LSS were enrolled .  Serum 25-hydroxyvitamin D ( 25-OHD ) level  was measured before the surgery and at 1 year postoperative visit . According to serum 25-OHD level , patients were classified into 3 groups : ( 1 ) deficient group , when 25-OHD level was less than 20 ng/mL ( < 50 nmol/L ) ; ( 2 ) insufficient group , when 25-OHD level was between 20 to 30 ng/mL ( 50 nmol/L ⩽ 25-OHD < 75 nmol/L ) ; ( 3 ) and normal group , when 25-OHD level was 30 ng/mL or more ( ≥75 nmol/L ) . The Oswestry Disability Index ( ODI ) score and health-related quality of life ( EQ-5D ) were compared according to the level of 25-OHD at 1 year postoperatively . Results . Preoperatively , there were 20 patients in the deficient group , 11 patients in the insufficient group and no patient in the normal group . There were no differences in age , body mass index , preoperative ODI scores , preoperative EQ-5D index scores , and EQ-5D visual analogue scale scores between the 2 groups . Mean preoperative 25-OHD level was 15.8 ng/mL ( range , 5.2–29.4 ng/mL ) and increased to 19.5 ng/mL ( range , 6.3–47.7 ng/mL ) 1 year after surgery ( P = 0.075 ) . Significant increase of 25-OHD was noted only in the deficient group ( P = 0.017 ) . Postoperatively , there were 18 patients in the deficient group , 8 patients in the insufficient group , and 5 patients in the normal group . In the postoperative deficient group , postoperative ODI scores and EQ-5D index scores showed significantly worse outcomes than those in the other groups . The changes in serum 25-OHD level were significantly correlated with the changes in ODI scores ( r = −0.580 ; P = 0.001 ) and with the changes in EQ-5D index scores ( r = 0.379 ; P = 0.035 ) . In all the groups , postoperative ODI scores ( r = −0.665 ; P < 0.001 ) and EQ-5D index scores ( r = 0.601 ; P < 0.001 ) were significantly correlated with postoperative 25-OHD level . Conclusion .  Vitamin D deficiency was common in patients with LSS . However , vitamin D status was improved after decompressive surgery , and postoperative 25-OHD level was significantly correlated with surgical outcomes Study Design . Clinical trial subgroup analysis . Objective . To compare outcomes of different fusion techniques treating degenerative spondylolisthesis ( DS ) . Summary of Background Data . Surgery has been shown to be more effective than nonoperative treatment out to 4 years . Questions remain regarding the differential effect of fusion technique . Methods . Surgical c and i date s from 13 centers in 11 states with at least 12 weeks of symptoms and confirmatory imaging showing stenosis and DS were studied . In addition to st and ard decompressive laminectomy , 1 of 3 fusion techniques was employed at the surgeon ’s discretion : posterolateral in situ fusion ( PLF ) ; posterolateral instrumented fusion with pedicle screws ( PPS ) ; or PPS plus interbody fusion ( 360 ° ) . Main outcome measures were the SF-36 bodily pain ( BP ) and physical function ( PF ) scales and the modified Oswestry Disability Index ( ODI ) assessed at 6 weeks , 3 months , 6 months , and yearly to 4 years . The as-treated analysis combined the r and omized and observational cohorts using mixed longitudinal models adjusting for potential confounders . Results . Of 380 surgical patients , 21 % ( N = 80 ) received a PLF ; 56 % ( N = 213 ) received a PPS ; 17 % ( N = 63 ) received a 360 ° ; and 6 % ( N = 23 ) had decompression only without fusion . Early outcomes varied , favoring PLF compared to PPS at 6 weeks ( PF : 12.73 vs. 6.22 , P < 0.020 ) and 3 months ( PF : 25.24 vs.18.95 , P < 0.025 ) and PPS compared to 360 ° at 6 weeks ( ODI : −14.46 vs. −9.30 , P < 0.03 ) and 3 months ( ODI : −22.30 vs. −16.78 , P < 0.02 ) . At 2 years , 360 ° had better outcomes : BP : 39.08 versus 29.17 PLF , P < 0.011 ; and versus 29.13 PPS , P < 0.002 ; PF : 31.93 versus 23.27 PLF , P < 0.021 ; and versus 25.29 PPS , P < 0.036 . However , these differences were not maintained at 3- and 4-year follow-up , when there were no statistically significant differences between the 3 fusion groups . Conclusion . In patients with DS and associated spinal stenosis , no consistent differences in clinical outcomes were seen among fusion groups over 4 years Study Design . Prospect i ve observational study . Objective . To determine whether polymorphic variations of the guanosine triphosphate ( GTP ) cyclohydrolase 1 gene ( GCH1 ) are associated with different outcomes in patients undergoing surgical treatment for lumbar degenerative disc disease ( DDD ) . Summary of Background Data . GCH1 , the gene encoding the rate-limiting enzyme in tetrahydrobiopterin synthesis , has been strongly implicated as a determinant of pain experience in previous animal and human studies . Methods . A total of 69 patients undergoing surgical treatment for lumbar DDD were prospect ively enrolled .  Genomic DNA was extracted from a venous blood sample , and DNA sequence analysis was performed of GCH1 . Surgery included 65 instrumented fusions and 4 disc arthroplasty  procedures . Patients were observed prospect ively for 1 year following surgery . Allelic and genotype frequencies were calculated for each of 14 single nucleotide polymorphisms ( SNPs ) . One-year postoperative Oswestry Disability Index ( ODI ) scores were compared to preoperative scores and the absolute change in ODI score was used to perform genetic association analyses on the basis of both individual SNP markers as well as commonly observed haplotypes for the entire gene sequence . Results . Single marker analysis revealed 1 SNP ( rs998259 ; minor allele T ) that was significantly associated with improvement in both absolute ODI score ( P = 0.030 ) and Numerical Rating Scale back pain scores ( P = 0.033 ) following surgery . Haplotype analysis identified a common GCH1 haplotype ( “ CACTTGTTTGAC ” ) with a sample frequency of 12.3 % , which was highly associated with improvement in absolute ODI score ( P = 0.04 ) . This haplotype frequency reflects the existence of both heterozygous and homozygous individuals in the study population . The presence of 1 unit of this haplotype was associated with an improvement in postoperative ODI score of 15.34 relative to the absence of this haplotype ( P = 0.04 ) . Conclusion . Preliminary results from this pilot genetic study of patients undergoing surgery for DDD suggests that the T allele at rs998259 of GCH1 may be associated with improved outcomes 1 year following surgery Abstract . The literature on the efficacy of traction in the treatment of low back pain ( LBP ) is conflicting . The aim of this study was to examine its efficacy in this disorder . Forty-two patients with at least 6 weeks of nonspecific LBP were selected . Demographic data were obtained . All patients completed the Oswestry disability index ( ODI ) to assess disability and the 10-cm visual analog scale ( VAS ) for evaluation of pain . Subjects were r and omly assigned into group 1 , receiving only st and ard physical therapy , or group 2 , receiving st and ard physical therapy with conventional lumbar traction . St and ard physical therapy consisted of local heat , ultrasound for the lumbar region , and an active exercise program , given for ten sessions in all . The subjects received instruction on correct posture and recommended therapeutic exercises . They were reevaluated at the end of treatment and at 3-month follow-up . The mean outcome measures were global improvement and satisfaction with the therapy , as well as disability by ODI and pain by VAS . There were no group differences in terms of demographic and baseline clinical characteristics . There was a significant reduction in pain intensity and disability at the end of treatment in both groups . There was complete or mild improvement in 47.6 % of group 1 and 40 % of group 2 . The satisfaction rate with both treatments was more than 70 % immediately after the therapies . During the 3-month period , the outcome measures except disability remained statistically stable , with no difference amongst groups . Disability was significantly reduced at follow-up in both groups . Of the patients , 51 % continued with the recommended exercises and had significantly lower disability scores than those who did not continue with the exercises . Pain and global improvement were also better in this group , but the difference was not statistically significant . In conclusion , no specific effect of traction on st and ard physical therapy was observed in our study group . We suggest focusing on back education and exercise therapy in the management of patients suffering from this chronic condition Background Identifying all existing evidence is a crucial aspect in conducting systematic review s. Since the retrieval of electronic data base search es alone is limited , guidelines recommend the use of additional search strategies . The aim of this investigation was to assess the efficiency and contribution of additional search strategies for identifying r and omized controlled trials in conducting a systematic review on interventions after performing a sensitive electronic data base search . Design and Methods Seven electronic data bases , 3 journals and 11 systematic review s were search ed . All first authors of the included studies were contacted ; citation tracking and a search in clinical trial registers were performed . A priori defined evaluation criteria were calculated for each search strategy . Results A total of 358 full-text articles were identified ; 50 studies were included in the systematic review , wherefrom 84.0 % ( 42 ) were acquired by the sensitive electronic data base search and 16.0 % ( 8) through additional search strategies . Screening reference lists of related systematic review s was the most beneficial additional search strategy , with an efficiency of 31.3 % ( 5 ) and a contribution of 10.0 % ( 5/50 ) , whereas h and - search ing and author contacts contributed two and one additional studies , respectively . Citation tracking and search ing clinical trial registers did not lead to any further inclusion of primary studies . Conclusions Based on our findings , h and - search ing contents of relevant journals and screening reference lists of related systematic review s may be helpful additional strategies to identify an extensive body of evidence . In case of limited re sources , a sensitive electronic data base search may constitute an appropriate alternative for identifying relevant trials . Significance for public health Systematic review s provide the strongest form of evidence synthesis for therapeutic interventions and are of high relevance for decision makers in public health . Preparing high quality systematic review s can be very time-consuming since all existing evidence should be identified , but the retrieval of electronic data base search es is limited and therefore additional search strategies are recommended . However , the time needed for conducting full systematic review s does often not address the need for urgent evidence . Thus , priorities of summarizing all available evidence and providing fast evidence -based recommendations may conflict . So far , no consensus exists regarding which additional search strategies are beneficial and sparsely time-consuming for conducting systematic review s. We examined the efficiency and contribution of additional search strategies performed after a sensitive electronic data base search . Our results provide highly relevant information for research ers conducting systematic review s in various fields of public health research and for establishing guidelines for conducting rapid review Study Design .. Prospect i ve observational 1-year study . Objective .. To determine minimum clinical ly important difference ( MCID ) and substantial clinical benefit ( SCB ) of outcome measures in failed back surgery syndrome ( FBSS ) patients , as these metrics enable assessment of whether and when an intervention produces clinical ly meaningful effects in a patient . Summary of Background Data .. Several methods have been devised to quantify clinical ly important difference , but MCID and SCB for FBSS patients has yet to be determined . Methods .. Patients with persisting/recurrent low back pain ( LBP ) and /or leg pain after lumbar surgery who completed 16 weeks of treatment ( n = 105 ) at two hospitals in Korea from November 2011 to September 2014 were analyzed . Global perceived effect was used to determine receiver operating characteristic curves in visual analogue scale ( VAS ) , Oswestry disability index ( ODI ) , and short form-36 ( SF-36 ) in an anchor-based approach . Results .. MCIDs for ODI , LBP and leg pain VAS , physical component summary , mental health component summary ( MCS ) , and overall health scores of SF-36 were 9.0 , 22.5 , 27.5 , 10.2 , 4.0 , and 8.9 , and SCBs were 15.0 , 32.5 , 37.0 , 19.7 , 19.3 , and 21.1 , respectively . MCID and SCB area under the curve was ≥0.8 , and ≥0.7 , respectively . Conclusion .. LBP and leg pain VAS , ODI , and physical component summary of SF-36 may be used to measure responsiveness in FBSS patients . Level of Evidence : BACKGROUND CONTEXT Surgical treatment for lumbar degenerative disc disease ( DDD ) has been associated with highly variable results in terms of postoperative pain relief and functional improvement . Many experts believe that DDD should be considered a chronic pain disorder as opposed to a degenerative disease . Genetic variation of the catechol-O-methyltransferase ( COMT ) gene has been associated with variation in human pain sensitivity and response to analgesics in previous studies . PURPOSE To determine whether genetic variation of COMT is associated with clinical outcome after surgical treatment for DDD . STUDY DESIGN Prospect i ve genetic association study . PATIENT SAMPLE Sixty-nine patients undergoing surgical treatment for lumbar DDD . Diagnosis was based on documentation of chronic disabling low back pain ( LBP ) present for a minimum of 6 months and unresponsive to supervised nonoperative treatment , including activity modification , medication , physical therapy , and /or injection therapy . Plain radiographs and magnetic resonance imaging revealed intervertebral disc desiccation , tears , and /or collapse without focal herniation , nerve root compression , stenosis , spondylolisthesis , spondylolysis , or alternative diagnoses . OUTCOME MEASURES Oswestry Disability Index ( ODI ) and visual analog score ( VAS ) for LBP . METHODS Surgical treatment included 65 instrumented fusions and four disc arthroplasty procedures . All patients completed preoperative and 1-year postoperative ODI question naires . DNA was extracted from a sample of venous blood , and genotype analysis was performed for five common COMT single nucleotide polymorphisms ( SNPs ) . Potential genetic association between these COMT SNPs and the primary outcome variable , 1-year change in ODI , was investigated using both single-marker and haplotype association analyses . Association with VAS scores for LBP was analyzed as a secondary outcome variable . RESULTS Single-marker analysis revealed that the COMT SNP rs4633 was significantly associated with greater improvement in ODI score 1 year after surgery ( p=.03 ) , with individuals homozygous for the less common " T " allele demonstrating the largest improvement in ODI . Haplotype analysis of four COMT SNPs , rs6269 , rs4633 , rs4818 , and rs4680 , also identified a common haplotype " ATCA " ( haplotype frequency of 39.3 % in the study population ) associated with greater improvement in ODI ( p=.046 ) . The greatest mean improvement in ODI was observed in patients homozygous for the " ATCA"COMT haplotype . A nonsignificant trend was observed between SNP rs4633 and greater improvement in VAS score for LBP . CONCLUSIONS This is the first study to report an association between surgical treatment success in DDD patients and genetic variation in the putative pain sensitivity gene COMT . These findings require replication in other DDD population s but suggest that genetic testing for pain-relevant genetic markers such as COMT may provide useful clinical information in terms of predicting outcome after surgery for patients diagnosed with DDD OBJECTIVE The aim of this study was to compare the effect of a short-term intensive residential yoga program with physical exercise ( control ) on pain and spinal flexibility in subjects with chronic low-back pain ( CLBP ) . DESIGN This was a wait-list , r and omized controlled study . SETTING The study was conducted at a residential integrative health center in Bangalore , South India . SUBJECTS Eighty ( 80 ) subjects ( females , n = 37 ) with CLBP , who consented were r and omly assigned to receive yoga or physical exercise  if they satisfied the selection criteria . INTERVENTION The intervention consisted of a 1-week intensive residential yoga program comprised of asanas ( physical postures ) design ed for back pain , pranayamas ( breathing practice s ) , meditation , and didactic and interactive sessions on philosophical concepts of yoga . The control group practice d physical exercises under a trained physiatrist and also had didactic and interactive sessions on lifestyle change . Both of the groups were matched for time on intervention and attention . OUTCOME MEASURES Pain-related outcomes were assessed by the Oswestry Disability Index ( ODI ) and by spinal flexibility , which was assessed using goniometer at pre and post intervention . Data were analyzed using repeated measures analysis of variance ( RMANOVA ) . RESULTS Data conformed to a Gaussian distribution . There was a significant reduction in ODI scores in the yoga group compared to the control group ( p = 0.01 ; effect size 1.264 ) . Spinal flexibility measures improved significantly in both groups but the yoga group had greater improvement as compared to controls on spinal flexion ( p = 0.008 ; effect size 0.146 ) , spinal extension ( p = 0.002 ; effect size 0.251 ) , right lateral flexion ( p = 0.059 ; effect size 0.006 ) ; and left lateral flexion ( p = 0.006 ; effect size 0.171 ) . CONCLUSIONS Seven ( 7 ) days of a residential intensive yoga-based lifestyle program reduced pain-related disability and improved spinal flexibility in patients with CLBP better than a physical exercise regimen The objective of this study was to assess which patient group had better outcomes for management of single level thoracolumbar spinal fractures . We prospect ively collected data on the outcomes of patients having either conservatively managed , traditional open surgery , or minimally interventional surgery ( MIS ) for treatment of a single level thoracolumbar fracture . All patients had previously asymptomatic spines prior to their fractures and had a single level thoracolumbar burst fracture of more than 20 ° kyphosis . Fractures treated operatively , either via open surgery or MIS techniques , were corrected to less than 10 ° of residual kyphosis using a monoaxial pedicle screw construct 2 levels above & 2 levels below the fracture posteriorly only . The metalwork was removed between 6 months and 1 year post operatively to remobilise the spinal segments . All patients were then evaluated at least 6 months after metal work removal and at 18 months post fracture using radiographs and the Oswestry Disability Index (ODI).Those patients treated with MIS techniques demonstrated superior outcomes compared to traditional open techniques and conservative methods of treatment , with significantly reduced hospital stay , better return to work & leisure , and the best chance of restoring their spine to near its pre-injury status . We would recommend MIS techniques as the best way of treating single level thoracolumbar spinal fractures . There is a significant improvement in ODI when treated by MIS over open surgical methods STUDY DESIGN A systematic review of r and omized and nonr and omized controlled trials . SUMMARY OF BACKGROUND DATA Lumbar supports are used in the treatment of low back pain , but also to prevent the onset ( primary prevention ) or recurrences of a low back pain episode ( secondary prevention ) . OBJECTIVES To assess the effects of lumbar sup-ports for prevention and treatment of nonspecific low back pain .  METHODS The Medline , Cinahl , and Current Contents data bases ; the Cochrane Controlled Trials Register up to September 1999 ; and the Embase data base up to September 1998 were all search ed . References of identified trials and systematic review s were review ed and the Science Citation Index used to identify additional trials . Method ologic quality assessment and data extraction were performed by two review ers independently . A quantitative analysis was performed in which the strength of evidence was classified as strong , moderate , limited or conflicting , and no evidence . RESULTS Five r and omized and two nonr and omized preventive trials and six r and omized therapeutic trials were included in the review . Only 4 of the 13 studies were of high quality . There was moderate evidence that lumbar supports are not effective for primary prevention . No evidence was found on the effectiveness of lumbar supports for secondary prevention . The systematic review of therapeutic trials showed that there is limited evidence that lumbar supports are more effective than no treatment , whereas it is still unclear whether lumbar supports are more effective than other interventions for treatment of low back pain . CONCLUSIONS There continues to be a need for high quality r and omized trials on the effectiveness of lumbar supports . One of the most essential issues to tackle in these future trials seems to be the realization of adequate compliance
These data provide both validation and st and ards for other users and indicate the power of the instrument for detecting change in sample population s. CONCLUSIONS The  ODI  remains a valid and vigorous measure and has been a worthwhile outcome measure .
The behavior of the instrument is incompletely understood , particularly in sensitivity to real change
STUDY DESIGN The Oswestry Disability Index ( ODI ) has become one of the principal condition-specific outcome measures used in the management of spinal disorders .
This review is based on publications using the ODI identified from the authors ' personal data bases , the Science Citation Index , and h and search es of Spine and current textbooks of spinal disorders .
OBJECTIVES To review the versions of this instrument , document methods by which it has been vali date d , collate data from scores found in normal and back pain population s , provide curves for power calculations in studies using the ODI , and maintain the ODI as a gold st and ard outcome measure .
SUMMARY OF BACKGROUND DATA It has now been 20 years since its original publication .
More than 200 citations exist in the Science Citation Index .