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SRS-22R Minimum Clinically Important Difference and Substantial Clinical Benefit After Adult Lumbar Scoliosis Surgery

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Abstract

Study Design

Longitudinal cohort.

Objectives

To determine if the minimum clinically important difference (MCID) and substantial clinical benefit (SCB) thresholds for the Scoliosis Research Society—22R (SRS22R) domains in patients with degenerative lumbar scoliosis are similar to those in patients with adult spinal deformity (ASD) with fusions extending into the thoracic spine.

Summary of Background Data

The MCID and SCB thresholds for the SRS22R domains in patients with ASD and adolescent idiopathic scoliosis have been reported.

Methods

Patients enrolled in the NIH-sponsored Adult Symptomatic Lumbar Scoliosis (ASLS) trial who underwent surgery and completed the SRS22R preoperative and the SRS30 one-year postoperative were identified. One-year postoperative answers to the last eight questions of the SRS30 were used as anchors to determine the MCID and SCB for the Pain, Appearance, and Activity domains, and the Subscore and Total score using receiver operating characteristic (ROC) curve analysis.

Results

The sample population consisted of 147 patients. A total of 132 (89%) were females with a mean age of 59.4 years. There was a statistically significant improvement in all SRS22R scores from preoperative to one-year postoperative. There was also a statistically significant difference in domain scores among the different responses to the anchors. According to the ROC analysis, MCID was 1.17 for Appearance, 0.40 for Activity, 0.60 for Pain, 0.53 for Subscore, and 0.77 for Total; and SCB was 1.67 for Appearance, 0.60 for Activity, 0.62 for Subscore, and 1.11 for Total score. These are similar to previous reports of MCID and SCB thresholds for ASD patients who underwent fusion to the thoracic spine.

Conclusion

The MCID and SCB thresholds for the SRS22R domains in patients with adult symptomatic lumbar scoliosis are very similar to the threshold values previously reported for adult deformity patients.

Level of Evidence

Level II.

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Authors and Affiliations

  1. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA

    Leah Y. Carreon MD, MSc, Charles H. Crawford III MD & Steven D. Glassman MD

  2. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St. Louis, MO, 63110, USA

    Michael P. Kelly MD, Christine R. Baldus RN, MHA & Keith H. Bridwell MD

  3. Department of Orthopaedic Surgery, University of Louisville school of Medicine, 550 S. Jackson St., 1st Floor ACB, Louisville, KY, 40202, USA

    Charles H. Crawford III MD & Steven D. Glassman MD

  4. Department of Neurosurgery, University of Virginia, PO Box 800212, Charlottesville, VA, 22908, USA

    Christopher I. Shaffrey MD

Authors
  1. Leah Y. Carreon MD, MSc
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  2. Michael P. Kelly MD
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  3. Charles H. Crawford III MD
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  4. Christine R. Baldus RN, MHA
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  5. Steven D. Glassman MD
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  6. Christopher I. Shaffrey MD
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  7. Keith H. Bridwell MD
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Corresponding author

Correspondence to Leah Y. Carreon MD, MSc.

Additional information

Author disclosures

LYC (member of the University of Louisville Institutional Review Board; research committee member of the Scoliosis Research Society; grant to institution from the National Institutes of Health; consultancy fees from the Washington University at St. Louis, AO Spine, and Norton Healthcare; Research Funding for Minimize Implants Maximize Outcomes RCT 2013—current from the Orthopedic Research and Educational Fund, paid to institution, outside the submitted work; research funding for study: Evidence-Based Algorithm for the Surgical Treatment of Lumbosacral Spondylolisthesis—current from the Scoliosis Research Society, paid to institution, outside the submitted work; annual required continuing education for institutional review board members, from the University of Louisville Institutional Review Board; travel and accommodations for Study Planning Meetings 06/2012, 02/2014, and 06/2014, from the Association for Collaborative Spine Research; travel and accommodations for Study Planning Meetings 10/2013, 05/2014, 09/2014, 12/2014, 05/2015, 08/2015, 04/2016, and 08/2016/12/2016 from the Center for Spine Surgery and Research, Region of Southern Denmark; and other from NuVasive [Nuvasive provides funds directly to database company; no funds are paid directly to Individual or Individual’s Institution 06/2012-04/2015]); MPK (grant to institution from the National Institutes of Health; grants to institution from AO Spine, Barnes Jewish Foundation, Orthopedic Research Education Foundation, and Cervical Spine Research Society, all outside the submitted work; fellowship support from AO Spine and Orthopedic Research Education Foundation, both outside the submitted work); CHC (grant to institution from the National Institutes of Health; consultancy fees from Alphatec, Medtronic, Norton Healthcare, and University of Louisville; grants to institution from the National Institutes of Health, Orthopedic Research Education Foundation, and Norton Healthcare; payment for lectures including service on speakers bureaus from DePuy Synthes; travel support from North American Spine Society and Scoliosis Research Society committee meetings; and other); CRB (grant to institution from the National Institutes of Health); SDG (grant to institution from the National Institutes of Health; employee of Norton Healthcare; patents issued for Medtronic; royalties from Medtronic; and other from NuVasive [NuVasive provides funds directly to database company; no funds are paid directly to Individual or Individual’s Institution 06/2012-04/2015]); CIS (grant to institution from the National Institutes of Health; consultancy fees from Stryker and K2M; grants to institution from the Department of Defense and the International Spine Study Group; royalties from Biomet, Medtronic, and NuVasive; stocks/stock options in NuVasive; and fellowship support from AOSpine and NREF); KHB (grant to institution from the National Institutes of Health and royalties from Wolters-Kluwer).

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Carreon, L.Y., Kelly, M.P., Crawford, C.H. et al. SRS-22R Minimum Clinically Important Difference and Substantial Clinical Benefit After Adult Lumbar Scoliosis Surgery. Spine Deform 6, 79–83 (2018). https://doi.org/10.1016/j.jspd.2017.05.006

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  • DOI: https://doi.org/10.1016/j.jspd.2017.05.006

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