Related Experiment Video
Updated: Aug 15, 2025
Clinical Application of Microscope-Assisted Minimally Invasive Anterior Lumbar Interbody Fusion
Published on: June 16, 2023
Establishing minimum clinically important difference for patient-reported outcome measures in patients undergoing
James W Nie1, Timothy J Hartman1, Keith R MacGregor1
1Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, IL, 60612, Chicago, USA.
Background:
The minimum clinically important difference (MCID) has not been established in lateral lumbar interbody fusion (LLIF). Our study aims to establish MCID for patient-reported outcome measures (PROMs) of physical function and pain for LLIF through anchor-based and distribution-based approaches.
Methods:
Patients undergoing LLIF with preoperative and 6-month postoperative Oswestry Disability Index (ODI) scores were identified. PROMs of Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF), 12-Item Short Form Physical Component Score (SF-12 PCS), Veterans RAND 12-Item Short Form Physical Component Score (VR-12 PCS), visual analog scale (VAS) back, and VAS leg were collected at preoperative and 6-month postoperative time points. Anchor-based MCID calculations were average change, minimal detectable change, change difference, receiver operating characteristic curve, and cross-sectional analysis using ODI as the anchor. Distribution-based calculations were standard error of measurement, reliable change index, effect size, and 0.5 ∗ ΔSD.
Results:
Fifty patients were included. Anchor-based approaches MCID ranges were PROMIS-PF 1.1-9.6, SF-12 PCS 6.4-16.5, VR-12 PCS 5.9-12.9, VAS Back 1.4-4.6, and VAS Leg 1.3-4.3. The area under curve for receiver operating characteristics (ROC) analysis ranged from 0.63 to 0.71. Distribution-based MCID ranges were PROMIS-PF 1.4-4.5, SF-12 PCS 1.9-12.7, VR-12 PCS 2.0-6.6, VAS Back 0.4-1.4, and VAS Leg 0.5-2.0.
Conclusion:
MCID thresholds varied widely depending on the calculation method. The closest to (0,1) ROC approach was the most clinically appropriate MCID calculation. The corresponding MCID values for LLIF were PROMIS-PF at 7.8, SF-12 PCS at 6.4, VR-12 PCS at 9.3, VAS Back at 4.6, and VAS Leg at 4.3.
Insights
This study establishes minimum clinically important difference (MCID) values for lateral lumbar interbody fusion (LLIF) using patient-reported outcome measures (PROMs). The findings provide crucial benchmarks for assessing treatment success in LLIF patients.
Area of Science:
- Spine surgery outcomes research
- Orthopedic patient-reported outcomes
Background:
- Lateral lumbar interbody fusion (LLIF) is a common spinal procedure.
- Establishing the minimum clinically important difference (MCID) for patient-reported outcome measures (PROMs) is crucial for evaluating LLIF success.
- MCID has not been previously established for LLIF.
Purpose of the Study:
- To establish MCID values for key PROMs assessing physical function and pain after LLIF.
- To utilize both anchor-based and distribution-based approaches for MCID determination.
- To provide clinically relevant benchmarks for LLIF outcomes.
Main Methods:
- Retrospective analysis of 50 patients undergoing LLIF.
- Collection of PROMs including Oswestry Disability Index (ODI), PROMIS-PF, SF-12 PCS, VR-12 PCS, VAS back, and VAS leg at baseline and 6 months.
- Application of multiple anchor-based (e.g., ROC analysis) and distribution-based methods for MCID calculation.
Main Results:
- Anchor-based MCID ranges varied across PROMs (e.g., PROMIS-PF: 1.1-9.6).
- Distribution-based MCID ranges also showed variability (e.g., PROMIS-PF: 1.4-4.5).
- Receiver operating characteristic (ROC) analysis indicated specific MCID values: PROMIS-PF 7.8, SF-12 PCS 6.4, VR-12 PCS 9.3, VAS Back 4.6, VAS Leg 4.3.
Conclusions:
- MCID thresholds for LLIF differ significantly based on the calculation method.
- The (0,1) ROC approach is identified as the most clinically appropriate method for determining MCID in LLIF.
- Established MCID values offer essential guidance for interpreting patient outcomes after LLIF.
