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Using the Quality Outcomes Database to Identify Minimum Clinically Important Differences for Patients With Cervical

Anthony L Asher1, Nikita Lakomkin2, Praveen V Mummaneni3

  • 1Neuroscience Institute, Atrium Health and Carolina Neurosurgery & Spine Associates, Charlotte , North Carolina , USA.

Neurosurgery
|January 9, 2026
PubMed
Summary

This study defines optimal minimum clinically important differences (MCIDs) for patient-reported outcome metrics (PROMs) in cervical spondylotic myelopathy (CSM). A 30% improvement is ideal for NDI and pain scales, while EQ-5D and mJOA scores require specific numeric or severity-adjusted MCIDs.

Keywords:
Arm painCervical stenosisEQ-5DMCIDNeck Disability IndexNeck painQuality outcomes database

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Area of Science:

  • Orthopedics
  • Neurosurgery
  • Health Outcomes Research

Background:

  • Cervical spondylotic myelopathy (CSM) treatment outcomes are assessed using patient-reported outcome metrics (PROMs).
  • Consensus on calculating minimum clinically important differences (MCIDs) for PROMs in CSM is lacking.
  • Optimal MCIDs are crucial for interpreting treatment efficacy and guiding clinical decisions.

Purpose of the Study:

  • To identify and define the optimal MCIDs for commonly used PROMs in patients with CSM.
  • To establish reliable benchmarks for assessing treatment impact in CSM.

Main Methods:

  • Retrospective analysis of the Quality Outcomes Database SpineCORe Study Group CSM cohort.
  • Collected baseline, 3-month, and 24-month PROM data for Neck Disability Index (NDI), EQ-5D, mJOA score, and neck/arm pain NRS.
  • Calculated MCIDs using validated techniques and compared methods via area under the curve (AUC) with patient satisfaction as an anchor.

Main Results:

  • A ≥30% improvement from baseline was the optimal MCID for NDI and neck/arm NRS.
  • Absolute numeric cutoffs (0.065 at 3 months; 0.149 at 24 months) were superior for EQ-5D.
  • A severity-adjusted MCID outperformed other methods for the mJOA score (AUC 0.67 at 24 months).
  • MCIDs were achieved by 52-63% of patients at 24 months across PROMs.

Conclusions:

  • Optimal MCIDs for key PROMs in CSM were defined using the SpineCORe dataset.
  • A ≥30% improvement is recommended for NDI and NRS, an absolute numeric cutoff for EQ-5D, and a severity-adjusted MCID for mJOA score.
  • These redefined benchmarks enhance the interpretation of treatment effects and support informed care decisions for CSM patients.