Skip to main content

Minimum clinically important difference in outcome scores among patients undergoing cervical laminoplasty

Abstract

Purpose

Minimum clinically important difference (MCID) represents the smallest change in an outcome measure recognized as clinically meaningful to a patient and is one of the most important psychometric parameters for assessing the postoperative results of spinal surgery. The purpose of the present study was to elucidate MCIDs for four common outcome measures used for degenerative cervical myelopathy in the context of patients undergoing laminoplasty.

Methods

We retrospectively reviewed a consecutive series of cervical laminoplasties in a single academic institution. Pre- and postoperative Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), Short Form-36 (SF-36), Neck Disability Index (NDI), and EuroQOL (EQ-5D) scores were obtained. Patients were also asked to answer the anchor question regarding satisfaction with treatment, and the anchor-based method was used to determine cut-off values for MCIDs.

Results

A total of 101 patients were included in the analysis. All outcome scores showed significant improvement postoperatively, with the exception of JOACMEQ bladder function score and SF-36 mental component summary score. Most patients (66%) were at least “somewhat satisfied” with treatment results. Receiver operating characteristic curve analyses revealed MCIDs of 2.5 for JOACEMQ cervical spine function, 13.0 for upper extremity function, 9.35 for lower extremity function, 9.5 for QOL, 3.9 for SF-36 physical component summary score, 4.2 for NDI, and 0.0485 for EQ-5D.

Conclusion

The MCIDs of four outcome measures were determined for patients undergoing cervical laminoplasty.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    Article  Google Scholar 

  2. Vernon H, Mior S (1991) The Neck Disability Index: a study of reliability and validity. J Manip Physiol Ther 14:409–415

    CAS  Google Scholar 

  3. EuroQol Group (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16:199–208

    Article  Google Scholar 

  4. Japanese Orthopaedic Association (1994) Scoring system for cervical myelopathy. J Jpn Orthop Assoc 68:490–503

    Google Scholar 

  5. Yonenobu K, Abumi K, Nagata K, Taketomi E, Ueyama K (2001) Interobserver and intraobserver reliability of the japanese orthopaedic association scoring system for evaluation of cervical compression myelopathy. Spine (Phila Pa 1976) 26:1890–1894 (discussion 1895)

    Article  CAS  Google Scholar 

  6. Benzel EC, Lancon J, Kesterson L, Hadden T (1991) Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord 4:286–295

    Article  CAS  PubMed  Google Scholar 

  7. Fukui M, Chiba K, Kawakami M, Kikuchi S, Konno S, Miyamoto M, Seichi A, Shimamura T, Shirado O, Taguchi T, Takahashi K, Takeshita K, Tani T, Toyama Y, Wada E, Yonenobu K, Tanaka T, Hirota Y, Subcommittee on Low Back P, Cervical Myelopathy Evaluation of the Clinical Outcome Committee of the Japanese Orthopaedic A (2007) An outcome measure for patients with cervical myelopathy: Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ): Part 1. J Orthop Sci 12:227–240. https://doi.org/10.1007/s00776-007-1118-1

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fukui M, Chiba K, Kawakami M, Kikuchi S, Konno S, Miyamoto M, Seichi A, Shimamura T, Shirado O, Taguchi T, Takahashi K, Takeshita K, Tani T, Toyama Y, Yonenobu K, Wada E, Tanaka T, Hirota Y (2007) Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire: part 3. Determination of reliability. J Orthop Sci 12:321–326. https://doi.org/10.1007/s00776-007-1131-4

    Article  PubMed  PubMed Central  Google Scholar 

  9. Chien A, Lai DM, Cheng CH, Wang SF, Hsu WL, Wang JL (2014) Translation, cross-cultural adaptation, and validation of a Chinese version of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. Spine (Phila Pa 1976) 39:963–970. https://doi.org/10.1097/brs.0000000000000313

    Article  Google Scholar 

  10. Witayakom W, Paholpak P, Jirarattanaphochai K, Kosuwon W, Sirichativapee W, Wisanuyotin T, Laupattarakasem P, Sukhonthamarn K, Jeeravipoolvarn P, Sakakibara T, Kasai Y (2016) Validation of the reliability of the Thai version of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). J Orthop Sci 21:124–127. https://doi.org/10.1016/j.jos.2015.12.017

    Article  PubMed  Google Scholar 

  11. de Vet HC, Terwee CB (2010) The minimal detectable change should not replace the minimal important difference. J Clin Epidemiol 63:804–805. https://doi.org/10.1016/j.jclinepi.2009.12.015

    Article  PubMed  Google Scholar 

  12. Ohya J, Oshima Y, Oka H, Saiki F, Taniguchi Y, Matsubayashi Y, Tanaka S, Chikuda H, Takeshita K (2016) Patient satisfaction with posterior decompression surgery for cervical ossification of the posterior longitudinal ligament: prognostic radiographic factors and patient-reported outcomes for the effectiveness of surgical treatment. World Neurosurg 96:272–279. https://doi.org/10.1016/j.wneu.2016.09.011

    Article  PubMed  Google Scholar 

  13. Wyrwich KW, Nienaber NA, Tierney WM, Wolinsky FD (1999) Linking clinical relevance and statistical significance in evaluating intra-individual changes in health-related quality of life. Med Care 37:469–478

    Article  CAS  PubMed  Google Scholar 

  14. Ware JE Jr (2000) SF-36 health survey update. Spine (Phila Pa 1976) 25:3130–3139

    Article  Google Scholar 

  15. Vernon H (2008) The Neck Disability Index: state-of-the-art, 1991–2008. J Manip Physiol Ther 31:491–502. https://doi.org/10.1016/j.jmpt.2008.08.006

    Article  Google Scholar 

  16. Janssen MF, Birnie E, Haagsma JA, Bonsel GJ (2008) Comparing the standard EQ-5D three-level system with a five-level version. Value Health 11:275–284. https://doi.org/10.1111/j.1524-4733.2007.00230.x

    Article  PubMed  Google Scholar 

  17. Zhang Y, Zhou F, Sun Y (2015) Assessment of health-related quality of life using the SF-36 in Chinese cervical spondylotic myelopathy patients after surgery and its consistency with neurological function assessment: a cohort study. Health Qual Life Outcomes 13:39. https://doi.org/10.1186/s12955-015-0237-1

    Article  PubMed  PubMed Central  Google Scholar 

  18. Carreon LY, Glassman SD, Campbell MJ, Anderson PA (2010) Neck Disability Index, short form-36 physical component summary, and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion. Spine J 10:469–474. https://doi.org/10.1016/j.spinee.2010.02.007

    Article  PubMed  Google Scholar 

  19. Auffinger BM, Lall RR, Dahdaleh NS, Wong AP, Lam SK, Koski T, Fessler RG, Smith ZA (2013) Measuring surgical outcomes in cervical spondylotic myelopathy patients undergoing anterior cervical discectomy and fusion: assessment of minimum clinically important difference. PLoS ONE 8:e67408. https://doi.org/10.1371/journal.pone.0067408

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Parker SL, Godil SS, Shau DN, Mendenhall SK, McGirt MJ (2013) Assessment of the minimum clinically important difference in pain, disability, and quality of life after anterior cervical discectomy and fusion: clinical article. J Neurosurg Spine 18:154–160. https://doi.org/10.3171/2012.10.SPINE12312

    Article  PubMed  Google Scholar 

  21. Chien A, Lai DM, Cheng CH, Wang SF, Hsu WL, Wang JL (2015) Responsiveness of the Chinese versions of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire and Neck Disability Index in postoperative patients with cervical spondylotic myelopathy. Spine (Phila Pa 1976) 40:1315–1321. https://doi.org/10.1097/brs.0000000000001005

    Article  Google Scholar 

  22. Zhou F, Zhang Y, Sun Y, Zhang F, Pan S, Liu Z (2015) Assessment of the minimum clinically important difference in neurological function and quality of life after surgery in cervical spondylotic myelopathy patients: a prospective cohort study. Eur Spine J 24:2918–2923. https://doi.org/10.1007/s00586-015-4208-3

    Article  PubMed  Google Scholar 

  23. Badhiwala JH, Witiw CD, Nassiri F, Akbar MA, Jaja B, Wilson JR, Fehlings MG (2018) Minimum clinically important difference in SF-36 scores for use in degenerative cervical myelopathy. Spine (Phila Pa 1976) 10:15. https://doi.org/10.1097/brs.0000000000002684

    Article  Google Scholar 

  24. Fukui M, Chiba K, Kawakami M, Kikuchi S, Konno S, Miyamoto M, Seichi A, Shimamura T, Shirado O, Taguchi T, Takahashi K, Takeshita K, Tani T, Toyama Y, Yonenobu K, Wada E, Tanaka T, Hirota Y, Subcommittee of the Clinical Outcome Committee of the Japanese Orthopaedic Association on Low Back P, Cervical Myelopathy E (2009) JOA Back Pain Evaluation Questionnaire (JOABPEQ)/JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The report on the development of revised versions. April 16, 2007. The Subcommittee of the Clinical Outcome Committee of the Japanese Orthopaedic Association on Low Back Pain and Cervical Myelopathy Evaluation. J Orthop Sci 14:348–365. https://doi.org/10.1007/s00776-009-1337-8

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Katsushi Takeshita.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 182 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kato, S., Oshima, Y., Matsubayashi, Y. et al. Minimum clinically important difference in outcome scores among patients undergoing cervical laminoplasty. Eur Spine J 28, 1234–1241 (2019). https://doi.org/10.1007/s00586-019-05945-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-019-05945-y

Keywords

  • Cervical laminoplasty
  • Minimum clinically important difference
  • Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire
  • Short Form-36
  • Neck Disability Index
  • EuroQOL