Neurosurgical focus最新文献

{"title":"Do patients with high ASA classes have sustained benefit 5 years after surgery for grade 2 spondylolisthesis? A Spine CORe™ analysis of QOD data.","authors":"Allie L Harbert, Aaron Gelinne, Valli P Mummaneni, Jay D Turner, Juan S Uribe, Anthony L Asher, Paul K Kim, Kai-Ming G Fu, Michael S Virk, Christopher I Shaffrey, Oren N Gottfried, Eric A Potts, Vincent J Alentado, Mohamad Bydon, Paul Park, Michael Y Wang, Steven D Glassman, Mladen Djurasovic, Kevin T Foley, Timothy J Yee, Andrew K Chan, Dean Chou, Nima Alan, Chun-Po Yen, Erica F Bisson, Vivian P Le, Regis Haid, Cheerag D Upadhyaya","doi":"10.3171/2025.12.FOCUS25959","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25959","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to assess whether the severity of systemic illness affects outcomes following surgery for grade 2 spondylolisthesis by using prospectively collected data from the Quality Outcomes Database (QOD) spondylolisthesis database.</p><p><strong>Methods: </strong>This retrospective analysis of patients who underwent surgery for grade 2 degenerative lumbar spondylolisthesis used a prospective national longitudinal registry of data collected from 14 sites. The American Society of Anesthesiologists (ASA) physical classification system was used to assess systemic illness and compare patients categorized as ASA classes I and II with patients categorized as ASA classes III and IV. Baseline demographics, comorbidities, and clinical variables were collected for comparison. Primary outcomes were Oswestry Disability Index (ODI) and EQ-5D scores 3, 12, 24, and 60 months after surgery, and multiple linear regression was used to determine whether ASA class significantly predicted postoperative change in patient-reported outcome measures.</p><p><strong>Results: </strong>Of the 328 patients in the grade 2 spondylolisthesis QOD cohort, 172 (52.4%) were categized as having a low ASA class (ASA class I or II) and 156 (47.6%) with a high ASA class (ASA class III or IV). There was a > 80% follow-up rate 5 years after surgery. Compared with patients in the low ASA class group, those in the high ASA class group were older (mean age 64.1 [SD 10.1] years vs 57.3 [SD 13.2] years, p < 0.001), had a higher BMI (mean 31.9 [SD 7.2] vs 28.8 [SD 5.9], p < 0.001), and had higher rates of comorbidities (diabetes, coronary artery disease, chronic obstructive pulmonary disease, and chronic kidney disease). The hospital length of stay and readmission rate did not differ significantly between the two groups. At baseline, ODI scores were significantly higher in the high ASA class group (mean 23.8 [SD 7.2] vs 21.5 [SD 8.3], p = 0.01), but there was not a significant difference in the ODI score 3, 12, 24, and 60 months after surgery. There were no significant differences in the mean EQ-5D score between the two groups at all time points. Multiple linear regression showed that ASA class was not a significant predictor of change in the ODI or EQ-5D score from baseline to 60 months postoperatively.</p><p><strong>Conclusions: </strong>Patients with higher systemic illness, categorized as ASA classes III or IV, had a higher baseline ODI score compared with those with low ASA classes (I or II), but had similar ODI scores 3, 12, 24, and 60 months postoperatively. There were no significant differences in the length of stay or readmission rate between groups. These findings suggest that patients with high ASA classes benefit from surgery for grade 2 spondylolisthesis and experience significant improvements in disability status.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E18"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there discordance between achieving the minimal clinically important difference in Neck Disability Index score and patient satisfaction after surgery for cervical spondylotic myelopathy? A Spine CORe™ 5-year analysis of QOD data.","authors":"Nima Alan, Jay Kumar, Abraham Dada, Mahmoud Elguindy, Erica F Bisson, Mohamad Bydon, Anthony L Asher, Paul K Kim, Eric A Potts, Kevin T Foley, Vincent J Alentado, Michael Y Wang, Kai-Ming Fu, Michael S Virk, Christopher I Shaffrey, Oren N Gottfried, John J Knightly, Scott Meyer, Paul Park, Cheerag D Upadhyaya, Chun-Po Yen, Andrew K Chan, Luis M Tumialán, Dean Chou, Juan S Uribe, Jay D Turner, Timothy J Yee, Regis W Haid, Praveen V Mummaneni","doi":"10.3171/2025.12.FOCUS25946","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25946","url":null,"abstract":"<p><strong>Objective: </strong>Minimal clinically important difference (MCID) thresholds are widely used to evaluate outcomes after surgery for cervical spondylotic myelopathy (CSM), but they may not fully reflect patient satisfaction. The authors hypothesized that discordance exists between MCID achievement in Neck Disability Index (NDI) score and satisfaction at long-term follow-up in a minority of patients after surgery for CSM.</p><p><strong>Methods: </strong>The 14-site Spine CORe™ study group performed a post hoc analysis of their prospectively collected data from the Quality Outcomes Database, which included 1085 patients who underwent surgery for CSM. Patients with complete baseline and 5-year NDI scores as well as 5-year satisfaction data were included. Satisfaction was assessed using the North American Spine Society (NASS) satisfaction index, and the MCID was defined for the NDI score. Baseline characteristics and patient-reported outcomes were compared between satisfied and dissatisfied patients within the cohort who met the MCID for NDI score. Multivariate logistic regression identified predictors of dissatisfaction despite the MCID.</p><p><strong>Results: </strong>In total, 1085 patients underwent surgery for CSM. The 5-year follow-up rate was 82% (106 died within 5 years, and 782 had both 5-year satisfaction and NDI data). At 5 years postoperatively, 497 patients (63.6%) achieved the MCID in NDI score. Among MCID achievers, 463 (93%) were satisfied and 34 (7%) were not satisfied. On univariate analysis, of those who met the MCID, dissatisfied patients were more likely to be current smokers (32.4% vs 15.8%, p = 0.029) and less likely to participate in outside activities (58.8% vs 85.1%, p < 0.001). They also presented with greater baseline disability (NDI score: 47.9 ± 18.2 vs 41.1 ± 19.5, p = 0.021), lower quality of life (EQ-5D score: 0.50 ± 0.19 vs 0.58 ± 0.22, p = 0.029), and lower preoperative functional status (mJOA score: 11.2 ± 2.8 vs 12.3 ± 2.7, p = 0.025) compared with satisfied patients. On multivariate analysis, of those who met the MCID, smoking showed a trend toward higher odds of dissatisfaction (OR 2.12, p = 0.065), while participation in outside activities was protective (OR 0.28, p < 0.001).</p><p><strong>Conclusions: </strong>In this study, only 7% of patients were dissatisfied despite achieving the MCID for NDI score. Participation in outside activities was independently associated with greater satisfaction, whereas smoking showed a trend toward increased dissatisfaction despite meeting the MCID for NDI score. The MCID and satisfaction capture distinct yet complementary aspects of recovery and should be jointly considered during preoperative counseling and postoperative outcome assessment.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E13"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the average time frame of clinically meaningful improvement in surgical decompression for cervical spondylotic myelopathy? A Spine CORe™ analysis of QOD data: 5-year follow-up.","authors":"Connor Berlin, Izza Tahir, Nicholas Cassimatis, Maliya Delawan, Gracie Garcia, Ben Setaro, Praveen V Mummaneni, Andrew K Chan, Dean Chou, Kai-Ming Fu, Erica F Bisson, Christopher I Shaffrey, Oren N Gottfried, Anthony L Asher, Paul K Kim, Eric A Potts, Vincent J Alentado, Kevin T Foley, Michael Y Wang, Michael S Virk, John J Knightly, Scott Meyer, Paul Park, Cheerag D Upadhyaya, Luis M Tumialán, Jay D Turner, Juan S Uribe, Regis W Haid, Timothy J Yee, Mohamad Bydon, Chun-Po Yen","doi":"10.3171/2025.12.FOCUS25943","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25943","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to determine the time frame of clinical improvement in patient-reported outcomes (PROs) following surgical decompression for cervical spondylotic myelopathy (CSM). Based on previously published 12-month data from this group, the authors hypothesized that the average time to minimal clinically important difference (MCID) improvement would primarily occur by 3 months postoperatively regardless of preoperative myelopathy severity. They also hypothesized that there would be minimal additional improvement between 3 months and 5 years after surgery.</p><p><strong>Methods: </strong>This was a post hoc analysis of prospectively collected data from the 14-site Spine CORe™ study group of the Quality Outcomes Database (QOD). Patients were stratified according to myelopathy severity using the modified Japanese Orthopaedic Association (mJOA) myelopathy scale into mild (mJOA score 15-17), moderate (mJOA score 12-14) or severe (mJOA score < 12). PRO measures included the Neck Disability Index (NDI), numeric rating scale (NRS) for neck and arm pain, and EQ-5D for quality-adjusted life years. PROs were recorded at baseline, 3-month, 12-month, 2-year, and 5-year intervals. MCID thresholds were calculated using previously validated methods in this cohort. Time to meet the MCID cutoff and the proportion of patients achieving MCID at each time point were determined.</p><p><strong>Results: </strong>A total of 1085 patients (with ≥ 80% follow-up at 60 months for all PRO measures [PROMs]) were enrolled. Patients with more severe myelopathy had worse baseline comorbidities (e.g., BMI, American Society of Anesthesiology class, ambulation dependence) and lower PRO scores. Average PROs met the MCID threshold in each category at 3 months postoperatively, regardless of baseline myelopathy severity. Of the patients with complete 5-year follow-up data, the majority achieved the MCID cutoff threshold for PROMs at 3 months (50%-73%, depending on the PROM). A minority of patients went on to meet the MCID for PROMs at 12 months (12%-21%), 2 years (4%-8%), and 5 years (1%-6%). Between 4% and 25% of patients never achieved MCID cutoffs at any time point.</p><p><strong>Conclusions: </strong>On average, patients achieved clinically meaningful improvement in PROs at 3 months postoperatively, regardless of preoperative severity. While the majority (50%-73%, depending on the PROM) reached MCID within 3 months, an additional 12%-21% improved by 12 months, 4%-8% by 2 years, and only 1%-6% by 5 years; 4%-25% never reach the MCID. This 5-year follow-up study clarifies the timeline of clinical improvement after surgery for CSM and provides a useful tool for both surgeon planning and patient counseling.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E11"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What are the predictors of prolonged length of stay following single-stage lumbar fusion for grade 2 spondylolisthesis? A Spine CORe™ analysis of QOD data.","authors":"Michael D White, Izza Tahir, Maliya Delawan, Anthony L Asher, Paul K Kim, Kai-Ming G Fu, Michael S Virk, Christopher I Shaffrey, Oren N Gottfried, Eric A Potts, Vincent J Alentado, Paul Park, Michael Y Wang, Steven D Glassman, Mladen Djurasovic, Kevin T Foley, Cheerag D Upadhyaya, Timothy J Yee, Andrew K Chan, Dean Chou, Praveen V Mummaneni, Chun-Po Yen, Erica F Bisson, Regis W Haid, Juan S Uribe, Jay D Turner, Mohamad Bydon","doi":"10.3171/2025.12.FOCUS25958","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25958","url":null,"abstract":"<p><strong>Objective: </strong>Prolonged hospital length of stay (LOS) is an increasingly important quality metric among regulators and payers that has been associated with worse patient outcomes and decreased patient satisfaction. The aim of this study was to identify predictors of prolonged hospital LOS after surgery for Meyerding grade 2 spondylolisthesis using a multicenter prospectively collected registry.</p><p><strong>Methods: </strong>The prospectively collected Spine CORe™ Quality Outcomes Database (QOD) study group cohort, which consisted of 328 patients from 14 sites, was used to identify all patients who underwent single-stage lumbar fusion for Meyerding grade 2 lumbar spondylolisthesis. Prolonged LOS was defined as ≥ 4 days (75th percentile). An array of demographic, comorbidity, and perioperative factors known to impact LOS were collected for each patient. Bivariate tests, including the chi-square goodness of fit and independent t-test, were used to identify variables associated with prolonged LOS. Multivariable logistic regression analysis was conducted to determine independent predictors of prolonged LOS.</p><p><strong>Results: </strong>The QOD cohort comprised 328 patients with a follow-up rate of > 80%. After excluding patients with an anterior or lateral surgical approach and missing LOS data, the final cohort included 268 patients, of whom 52 (19.4%) experienced a prolonged LOS. In the univariate analysis, older age, dependent ambulation, insurance status, depression, greater estimated blood loss, longer operative duration, multilevel fusion (2 or more levels), perioperative complications (e.g., incidental durotomy and urinary tract infection), and nonhome discharge were associated with prolonged LOS. In the adjusted model, multilevel arthrodesis independently increased the odds of prolonged LOS (OR 2.11, 95% CI 1.07-4.18; p = 0.03), whereas private insurance (vs Medicare/Medicaid/government) was associated with lower odds (OR 0.42, 95% CI 0.20-0.87; p = 0.02). Patient-reported outcomes at 60 months did not differ between the groups with and without prolonged LOS.</p><p><strong>Conclusions: </strong>In this multicenter Spine CORe™ QOD study, multilevel lumbar fusion and noncommercial insurance were the principal independent predictors of prolonged LOS after surgery for grade 2 spondylolisthesis. These findings are valuable for patient informed consent, as well as to identify higher-risk patients who could benefit from earlier inpatient resource allocation (social work and counseling) to facilitate timely discharge.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E17"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What are the predictors of nonroutine discharge after surgery for grade 2 lumbar spondylolisthesis? A Spine CORe™ analysis of QOD data.","authors":"Joseph R Linzey, Allie Harbert, Aaron Gelinne, Cheerag D Upadhyaya, Jay D Turner, Juan S Uribe, Anthony L Asher, Paul K Kim, Kai-Ming G Fu, Michael S Virk, Christopher I Shaffrey, Oren N Gottfried, Eric A Potts, Vincent J Alentado, Mohamad Bydon, Paul Park, Michael Y Wang, Steven D Glassman, Mladen Djurasovic, Kevin T Foley, Andrew K Chan, Dean Chou, Praveen V Mummaneni, Chun-Po Yen, Erica F Bisson, Regis Haid, Timothy J Yee","doi":"10.3171/2025.12.FOCUS25955","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25955","url":null,"abstract":"<p><strong>Objective: </strong>Discharge to an inpatient rehabilitation facility or other acute care facility is a significant driver of healthcare costs. The authors sought to identify predictors of nonroutine discharge after surgery for grade 2 lumbar spondylolisthesis.</p><p><strong>Methods: </strong>The Quality Outcomes Database from the 14 highest enrolling sites (Spine CORe™ study group) was queried for adult patients who underwent surgery for grade 2 lumbar spondylolisthesis. Nonroutine discharge was defined as discharge to a postacute or nonacute care setting or transfer to another acute care facility. Univariate analysis and multivariate logistic regression were utilized to identify predictors of nonroutine discharge. The follow-up rate at 5 years was 81%.</p><p><strong>Results: </strong>Of the 328 patients identified, 47 (14.3%) had nonroutine discharge. On univariate analysis, patients with nonroutine discharge were more likely to be older (67.4 ± 11.3 years vs 59.4 ± 12.2 years, p < 0.0001), be female (85.1% vs 65.5%, p = 0.007), have diabetes (36.2% vs 12.1%, p < 0.0001), have osteoporosis (21.3% vs 8.2%, p = 0.02), have a higher mean baseline numeric rating scale (NRS) leg pain score (7.5 ± 2.2 vs 6.6 ± 2.8, p = 0.04), and have a higher mean baseline Oswestry Disability Index (ODI) score (55.4 ± 15.7 vs 46.5 ± 16.5, p = 0.0006) compared to patients with a routine discharge. Patients who had completed a 4-year college degree, were employed and working, and were independently ambulatory were more likely to have a routine discharge (p < 0.0001). Multivariate analysis showed that older age (OR 1.06, 95% CI 1.01-1.11, p = 0.01), female sex (OR 2.64, 95% CI 1.01-6.87, p = 0.04), need for an assistive device to ambulate preoperatively (OR 3.01, 95% CI 1.02-7.36, p = 0.02), and diabetes (OR 2.80, 95% CI 1.20-6.56, p = 0.02) were independently associated with nonroutine discharge. Patients with a nonroutine discharge had significantly greater length of stay compared to patients with a routine discharge (4.7 ± 2.2 vs 3.2 ± 2.1 days, p < 0.0001).</p><p><strong>Conclusions: </strong>In this large, prospective, multicenter study, patients with nonroutine discharge after surgery for grade 2 lumbar spondylolisthesis were more likely to be older, female, have diabetes, and require an assistive device to ambulate preoperatively.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E16"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does surgical treatment of grade 2 spondylolisthesis have sustained improvement in postoperative outcomes regardless of age? A Spine CORe™ analysis of QOD data.","authors":"Natasha Kharas, Anthony Robayo, Evan Wang, Jay D Turner, Juan S Uribe, Anthony L Asher, Paul K Kim, Christopher I Shaffrey, Oren N Gottfried, Eric A Potts, Vincent J Alentado, Mohamad Bydon, Paul Park, Michael Y Wang, Steven D Glassman, Mladen Djurasovic, Kevin T Foley, Cheerag D Upadhyaya, Timothy J Yee, Andrew K Chan, Dean Chou, Praveen V Mummaneni, Chun-Po Yen, Erica F Bisson, Regis Haid, Michael S Virk, Kai-Ming G Fu","doi":"10.3171/2025.12.FOCUS25947","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25947","url":null,"abstract":"<p><strong>Objective: </strong>Surgical intervention for grade 2 lumbar spondylolisthesis is routinely performed, but outcomes in older patients, in whom the disease is most prevalent, remain poorly understood. The aim of this study was to compare patient-reported surgical outcomes between age groups (< 65 years of age vs ≥ 65 years of age) with 5 years of follow-up. The authors hypothesized that patients would have sustained improvement in outcomes in response to surgical treatment for grade 2 spondylolisthesis regardless of age.</p><p><strong>Methods: </strong>The multicenter prospectively collected Quality Outcomes Database by the Spine CORe™ study group was retrospectively analyzed for patients who underwent arthrodesis for grade 2 lumbar spondylolisthesis. Across 14 high-enrolling sites, 328 patients with 81% follow-up were identified. Baseline and postoperative 3-month, 1-year, 2-year, and 5-year outcomes including numeric rating scale (NRS) back pain (score 0-10), NRS leg pain (score 0-10), Oswestry Disability Index (ODI), EQ-5D scores, and patient satisfaction using the North American Spine Society (NASS) index, were evaluated. These outcomes were compared between younger (< 65 years of age, n = 188) and older (≥ 65 years of age, n = 140) age groups using Wilcoxon rank-sum tests.</p><p><strong>Results: </strong>EQ-5D and ODI scores were significantly improved postoperatively in the younger and older age groups (p < 0.001). ODI scores were not significantly different between the age groups at baseline (p = 0.37) or postoperatively at any time point (p > 0.05). EQ-5D scores were not significantly different between the younger and older patient groups at baseline (p = 0.47) or postoperatively at any time point (p > 0.05). NRS leg pain (p = 0.68) and back pain (p = 0.45) scores were not significantly different at baseline across age groups. NRS leg pain was not significantly different postoperatively (p > 0.05). Older patients had lower back pain scores (p = 0.03) at 3 months postoperatively, but not at any other time points (p > 0.05). Leg and back pain scores improved postoperatively up to 5 years of follow-up in all patients (p < 0.0001). A majority of the younger (83.5%) and older (89.5%) patients reported satisfaction with their surgical outcome up to 5 years after surgery, and postoperative NASS satisfaction scores were not significantly different between the younger and older age groups at any time point (p > 0.05).</p><p><strong>Conclusions: </strong>In response to surgical treatment, patients over 65 years of age have significant improvements similar to those of younger patients. Surgical treatment is a viable option for improvement regardless of age.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E15"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147817938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What are minimal clinically important differences for patient-reported outcome measures after surgery for cervical spondylotic myelopathy? A 5-year Spine CORe™ analysis of QOD data.","authors":"Connor Berlin, Maliya Delawan, Irina-Mihaela Matache, Jean-Luc K Kabangu, Dayton Grogan, Gracie Garcia, Praveen V Mummaneni, Andrew K Chan, Dean Chou, Kai-Ming Fu, Erica F Bisson, Christopher I Shaffrey, Oren N Gottfried, Anthony L Asher, Paul Kim, Domagoj Coric, Eric A Potts, Vincent J Alentado, Kevin T Foley, Michael Y Wang, Michael S Virk, John J Knightly, Scott Meyer, Cheerag D Upadhyaya, Luis M Tumialán, Jay D Turner, Juan Uribe, Regis W Haid, Timothy J Yee, Chun-Po Yen, Mohamad Bydon, Paul Park","doi":"10.3171/2025.12.FOCUS25939","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25939","url":null,"abstract":"<p><strong>Objective: </strong>The minimal clinically important difference (MCID) is widely used to interpret patient-reported outcome measures (PROMs) in cervical spondylotic myelopathy (CSM). However, consensus on its definition is lacking, and its long-term consistency remains unknown. The objective of this study was to determine if MCID thresholds for PROMs at 5 years after surgery for CSM remained consistent when compared to previously established 2-year values.</p><p><strong>Methods: </strong>The Spine CORe™ study group performed a post hoc analysis of the prospective Quality Outcomes Database. Eight established anchor- and distribution-based methods were applied to define MCID thresholds for the following PROMs: Neck Disability Index (NDI), neck pain numeric rating scale (NP-NRS), arm pain numeric rating scale (AP-NRS), 5-dimension EuroQol health utility questionnaire (EQ-5D) for quality-adjusted life years, and modified Japanese Orthopaedic Association (mJOA) scores. Predictive validity was evaluated using area under the curve (AUC) analysis with North American Spine Society satisfaction as the anchor, and results were compared with calculated 2-year values from the same cohort using DeLong's test.</p><p><strong>Results: </strong>A total of 1085 patients were originally enrolled, with ≥ 80% follow-up for all PROMs except the mJOA score (79%). At 5 years, optimal percentage change and ≥ 30% improvement methods were consistently highest performing for the NDI (AUC 0.71 and 0.68, respectively), NP-NRS (AUC 0.65 for both), and AP-NRS (AUC 0.73 and 0.72, respectively) scores. For the EQ-5D score, both the optimal numeric cutoff and one-half standard deviation methods performed best, yielding a consistent MCID threshold of 0.11 (AUC 0.64 for both). For the mJOA score, the severity-adjusted method provided the strongest discrimination, with an AUC of 0.74 at 5 years. MCID thresholds were consistent between 2 and 5 years, except for the severity-adjusted MCID for the mJOA score (0.74 at 5 years vs 0.65 at 2 years, p = 0.026). The 30% improvement threshold corresponded to absolute changes of 11.3 points for the NDI score, 1.5 points for the NP-NRS score, and 1.4 points for the AP-NRS score based on mean baseline scores.</p><p><strong>Conclusions: </strong>To the authors' knowledge, this represents the largest cohort of patients with CSM in the United States with validated, long-term 5-year MCID thresholds. This study establishes practical MCID definitions for NDI (≥ 30% improvement threshold of 11.3 points), NP-NRS and AP-NRS (≥ 30% improvement thresholds of 1.5 and 1.4 points, respectively), EQ-5D (optimal numeric cutoff of 0.11), and mJOA (severity-adjusted: ≥ 3 points for severe, ≥ 2 for moderate, ≥ 1 for mild) scores that can serve as benchmarks for evaluating improvement after CSM surgery in both research and routine clinical practice.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E6"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction. Advancing evidence-based care in cervical spondylotic myelopathy and grade 2 spondylolisthesis: insights from the QOD Spine CORe™ program.","authors":"Praveen V Mummaneni, Erica F Bisson, Mohamad Bydon","doi":"10.3171/2025.12.FOCUS251027","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS251027","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E1"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147817916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is baseline Neck Disability Index a predictor of 5-year postoperative satisfaction in cervical spondylotic myelopathy? A Spine CORe™ analysis of QOD data.","authors":"Daniel Zeitouni, Izza Tahir, Irina-Mihaela Matache, Hendrik von Kentzinsky, Erica F Bisson, Eric A Potts, Vincent J Alentado, Kevin T Foley, Michael Y Wang, Kai-Ming Fu, Michael S Virk, Christopher I Shaffrey, Oren N Gottfried, John J Knightly, Scott Meyer, Paul Park, Cheerag D Upadhyaya, Chun-Po Yen, Andrew K Chan, Luis M Tumialán, Dean Chou, Juan S Uribe, Jay D Turner, Timothy J Yee, Regis W Haid, Praveen V Mummaneni, Mohamad Bydon, Anthony L Asher, Matthew J McGirt, Paul K Kim","doi":"10.3171/2025.12.FOCUS25944","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25944","url":null,"abstract":"<p><strong>Objective: </strong>Patient satisfaction is an important outcome to measure quality of care. The hypothesis of this study was that more severe baseline neck disability (Neck Disability Index [NDI] scores 70-100) is associated with less frequent postoperative satisfaction in cervical spondylotic myelopathy.</p><p><strong>Methods: </strong>This study used the 14-site Spine CORe™ study group's cervical dataset module from the Quality Outcomes Database, which included 1085 patients. Baseline demographics, clinical variables, and surgical parameters were collected. Patient-reported outcomes (PROs) collected include EQ-5D, NDI, and numeric rating scale for neck pain and arm pain scores. Heat maps were created to demonstrate the association of NDI scores with postoperative satisfaction.</p><p><strong>Results: </strong>There were 1085 patients in this study with a 5-year follow-up rate of 83% for the NDI. PROs significantly improved 1 and 5 years postoperatively. Multivariate regression models found baseline NDI scores to be associated with 1- and 5-year satisfaction (OR 0.98 [95% CI 0.97-0.99], p = 0.004). Heat maps were created to determine the significance of baseline, 1-year, and 5-year NDI scores on satisfaction rates. The level of satisfaction decreased with increasing 1- and 5-year NDI scores. Additionally, patients with higher baseline NDI scores required a more significant change in NDI to achieve satisfaction with surgery.</p><p><strong>Conclusions: </strong>Patients with more severe disability measured by the NDI require a greater change in postoperative NDI scores to meet satisfaction. Despite the importance of postoperative satisfaction, failure to achieve satisfaction should not be assumed to be due to lack of clinical benefit. Discussing a patient's goals and expectations preoperatively is essential to maximize the probability of achieving satisfaction.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E12"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for persistent arm pain 5 years after surgery for cervical spondylotic myelopathy: a Spine CORe™ analysis of QOD data.","authors":"Natasha Kharas, Graham Winston, Erica F Bisson, Mohamad Bydon, Anthony L Asher, Paul K Kim, Eric A Potts, Vincent J Alentado, Kevin T Foley, Michael Y Wang, Christopher I Shaffrey, Oren N Gottfried, John J Knightly, Scott Meyer, Paul Park, Cheerag D Upadhyaya, Andrew K Chan, Luis M Tumialán, Dean Chou, Juan S Uribe, Jay D Turner, Timothy J Yee, Regis W Haid, Praveen V Mummaneni, Kai-Ming Fu, Michael S Virk","doi":"10.3171/2025.12.FOCUS25935","DOIUrl":"https://doi.org/10.3171/2025.12.FOCUS25935","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The purpose of this study was to evaluate patients undergoing surgery for cervical spondylotic myelopathy who presented with severe arm pain to determine which factors are associated with persistent and improved postoperative arm pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Of the patients with CSM included from 14 Spine CORe™ study group sites participating in the Quality Outcomes Database, those who presented with severe arm pain preoperatively (numeric rating scale [NRS] scores 7-10) were selected for analysis. Within this subset, patients who reported persistent severe arm pain (NRS scores 7-10) postoperatively were compared with patients who had moderate and improved/mild arm pain (NRS scores 4-6 and 0-3, respectively) postoperatively. NRS scores for arm pain were recorded at baseline and postoperatively at 3 months, 1 year, 2 years, and 5 years. Demographics, comorbidities, and patient-reported outcome measures (Neck Disability Index [NDI], quality-adjusted life years [QALY], modified Japanese Orthopaedic Association [mJOA] scale, and EuroQol visual analog scale [EQ-VAS]) were evaluated. These factors were compared between patients with persistent and those with improved arm pain at the 5-year follow-up using the Wilcoxon rank-sum test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 1085 patients with CSM, 458 reported severe arm pain (NRS scores 7-10) preoperatively. Of these, 60.7% of patients reported mild arm pain (NRS scores 0-3), 20.4% reported moderate arm pain (NRS scores 4-6), and 18.9% reported persistent severe arm pain (NRS scores 7-10) at the 5-year follow-up. Patients with persistent severe pain had significantly higher NDI scores (p = 0.001) and lower mJOA (p = 0.04), QALY (p = 0.02), and EQ-VAS (p &lt; 0.00001) scores at baseline. Patients with mild/improved arm pain were significantly more likely to have postgraduate education (p = 0.04). Patients with early postoperative improvement in arm pain (at 3 months, p &lt; 0.0001) had sustained improvement through the 5-year postoperative time point. However, patients with persistent severe pain at 5 years had consistently higher pain at all postoperative time points (3 months, 1 year, and 2 years), which significantly worsened between the 2- and 5-year time points (mean NRS scores from 4.8 to 8, p &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Among patients who underwent surgery for CSM who presented with severe radicular arm pain (NRS scores 7-10), 81.1% reported improvement (NRS scores 0-6), and 18.9% reported persistent severe arm pain 5 years after surgery. Persistent arm pain was associated with increased preoperative disability (mJOA, NDI, QALY, and EQ-VAS), while postgraduate education was associated with improved arm pain. Patients with early postoperative improvement in arm pain demonstrated a durable result through 5 years of follow-up, which could improve further. Conversely, those with severe postoperative arm pain had persistent pain at 2 years, which further d","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"60 5","pages":"E5"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}