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J Neurosurg Spine. 2014 Jul;21(1):7-13. doi: 10.3171/2014.4.SPINE14258.

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 2: assessment of functional outcome following lumbar fusion.

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Alan and Jacqueline Stuart Spine Research Center, Department of Neurosurgery, Lahey Clinic, Burlington, and Tufts University School of Medicine, Boston, Massachusetts;


Assessment of functional patient-reported outcome following lumbar spinal fusion continues to be essential for comparing the effectiveness of different treatments for patients presenting with degenerative disease of the lumbar spine. When assessing functional outcome in patients being treated with lumbar spinal fusion, a reliable, valid, and responsive outcomes instrument such as the Oswestry Disability Index should be used. The SF-36 and the SF-12 have emerged as dominant measures of general health-related quality of life. Research has established the minimum clinically important difference for major functional outcomes measures, and this should be considered when assessing clinical outcome. The results of recent studies suggest that a patient's pretreatment psychological state is a major independent variable that affects the ability to detect change in functional outcome.


BIS = Balanced Inventory for Spinal Disorders; DRI = Disability Rating Index; HR-QOL = health-related quality of life; ICC = intraclass correlation coefficient; LSOQ = Lumbar Spine Outcomes Questionnaire; MCID = minimum clinically important difference; MCS = mental component summary; ODI = Oswestry Disability Index; PCS = physical component summary; RMDQ = Roland-Morris Disability Questionnaire; ROC = receiver operating characteristic; SF-12 = 12-Item Short Form Health Survey; SF-36 = 36-Item Short Form Health Survey; SIP = Sickness Impact Profile; SRS-22 = 22-Item Scoliosis Research Society; VAS = visual analog scale; fusion; lumbar spine; practice guidelines; treatment outcomes

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