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External validation of a prediction model for pain and functional outcome after elective lumbar spinal fusion



Patient-reported outcome measures following elective lumbar fusion surgery demonstrate major heterogeneity. Individualized prediction tools can provide valuable insights for shared decision-making. We externally validated the spine surgical care and outcomes assessment programme/comparative effectiveness translational network (SCOAP-CERTAIN) model for prediction of 12-month minimum clinically important difference in Oswestry Disability Index (ODI) and in numeric rating scales for back (NRS-BP) and leg pain (NRS-LP) after elective lumbar fusion.


Data from a prospective registry were obtained. We calculated the area under the curve (AUC), calibration slope and intercept, and Hosmer–Lemeshow values to estimate discrimination and calibration of the models.


We included 100 patients, with average age of 50.4 ± 11.4 years. For 12-month ODI, AUC was 0.71 while the calibration intercept and slope were 1.08 and 0.95, respectively. For NRS-BP, AUC was 0.72, with a calibration intercept of 1.02, and slope of 0.74. For NRS-LP, AUC was 0.83, with a calibration intercept of 1.08, and slope of 0.95. Sensitivity ranged from 0.64 to 1.00, while specificity ranged from 0.38 to 0.65. A lack of fit was found for all three models based on Hosmer–Lemeshow testing.


The SCOAP-CERTAIN tool can accurately predict which patients will achieve favourable outcomes. However, the predicted probabilities—which are the most valuable in clinical practice—reported by the tool do not correspond well to the true probability of a favourable outcome. We suggest that any prediction tool should first be externally validated before it is applied in routine clinical practice.

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Correspondence to Victor E. Staartjes.

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Supplement 1 Statistical Code. The code was executed in R Version 3.5.4 (The R Foundation for Statistical Computing, Vienna, Austria) on a machine running Windows 10 (Microsoft Corp., Redmond, WA, USA). (PPTX 1304 kb)

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Quddusi, A., Eversdijk, H.A.J., Klukowska, A.M. et al. External validation of a prediction model for pain and functional outcome after elective lumbar spinal fusion. Eur Spine J 29, 374–383 (2020).

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  • Outcome prediction
  • Lumbar fusion
  • Patient-reported outcome
  • External validation
  • Predictive analytics