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Updated: Jan 23, 2026

Intraoperative Ultrasound in Spinal Surgery
Published on: August 17, 2022
Cultural Variations in the Minimum Clinically Important Difference Thresholds for SRS-22R After Surgery for Adult
Hideyuki Arima1, Leah Y Carreon2, Steven D Glassman3
1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192 Japan; Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202 USA; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY 40202 USA.
Study Design:
Longitudinal cohort.
Objective:
To calculate the minimum clinically important difference (MCID) threshold values for the Scoliosis Research Society-22R (SRS-22R) in Japanese patients with adult spinal deformity (ASD) and to compare the results with previously reported values in a North American population.
Summary Of Background Data:
The SRS-22R has been shown to be reliable, valid, and responsive to change in patients with ASD undergoing surgery. The MCID quantifies a threshold value of improvement that is clinically relevant to the patient. We hypothesize that MCID threshold values of SRS-22R differ between different cultural groups.
Methods:
We identified ASD patients who completed the SRS-22R preoperatively and the SRS-30 at minimum two years after surgery. Answers to the last seven questions of the SRS-30 were used as anchors to determine the MCID for the SRS-22R Activity, Pain, Appearance, Mental domains, and Total score using receiver operating characteristic (ROC) curve analysis.
Results:
A total of 122 (16 male, 106 female) patients were included in the analysis. There was a statistically significant improvement in all domain scores from preoperation to two years postoperation. There was a statistically significant difference in change in domain score among the responses to the anchors (p < .05). The ROC curve analysis yielded MCID values of 0.90 for Activity (area under the curve [AUC] = 0.766), 0.85 for Pain (AUC = 0.637), 1.05 for Appearance (AUC = 0.764), and 0.70 for Mental (AUC = 0.641) domain, 1.05 for Total score (AUC = 0.670). Except for Appearance, these MCID thresholds were higher compared with values reported in patients from North America (Activity = 0.60, Pain = 0.40, Appearance = 1.23, Total = 0.71).
Conclusions:
Results of this study showed that cultural variations exist for MCID threshold values for SRS-22 Activity, Pain, Mental domains, and Total score after surgical treatment of ASD.
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