{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:04:49Z","timestamp":1780131889926,"version":"3.54.0"},"reference-count":148,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The minimal clinically important difference (MCID) is widely used to interpret patient-reported outcome measures (PROMs) in cervical spondylotic myelopathy (CSM). However, consensus on its definition is lacking, and its long-term consistency remains unknown. The objective of this study was to determine if MCID thresholds for PROMs at 5 years after surgery for CSM remained consistent when compared to previously established 2-year values.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The Spine CORe\u2122 study group performed a post hoc analysis of the prospective Quality Outcomes Database. Eight established anchor- and distribution-based methods were applied to define MCID thresholds for the following PROMs: Neck Disability Index (NDI), neck pain numeric rating scale (NP-NRS), arm pain numeric rating scale (AP-NRS), 5-dimension EuroQol health utility questionnaire (EQ-5D) for quality-adjusted life years, and modified Japanese Orthopaedic Association (mJOA) scores. Predictive validity was evaluated using area under the curve (AUC) analysis with North American Spine Society satisfaction as the anchor, and results were compared with calculated 2-year values from the same cohort using DeLong\u2019s test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 1085 patients were originally enrolled, with \u2265 80% follow-up for all PROMs except the mJOA score (79%). At 5 years, optimal percentage change and \u2265 30% improvement methods were consistently highest performing for the NDI (AUC 0.71 and 0.68, respectively), NP-NRS (AUC 0.65 for both), and AP-NRS (AUC 0.73 and 0.72, respectively) scores. For the EQ-5D score, both the optimal numeric cutoff and one-half standard deviation methods performed best, yielding a consistent MCID threshold of 0.11 (AUC 0.64 for both). For the mJOA score, the severity-adjusted method provided the strongest discrimination, with an AUC of 0.74 at 5 years. MCID thresholds were consistent between 2 and 5 years, except for the severity-adjusted MCID for the mJOA score (0.74 at 5 years vs 0.65 at 2 years, p = 0.026). The 30% improvement threshold corresponded to absolute changes of 11.3 points for the NDI score, 1.5 points for the NP-NRS score, and 1.4 points for the AP-NRS score based on mean baseline scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>To the authors\u2019 knowledge, this represents the largest cohort of patients with CSM in the United States with validated, long-term 5-year MCID thresholds. This study establishes practical MCID definitions for NDI (\u2265 30% improvement threshold of 11.3 points), NP-NRS and AP-NRS (\u2265 30% improvement thresholds of 1.5 and 1.4 points, respectively), EQ-5D (optimal numeric cutoff of 0.11), and mJOA (severity-adjusted: \u2265 3 points for severe, \u2265 2 for moderate, \u2265 1 for mild) scores that can serve as benchmarks for evaluating improvement after CSM surgery in both research and routine clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.12.focus25939","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T11:31:11Z","timestamp":1777635071000},"page":"E6","source":"Crossref","is-referenced-by-count":0,"title":["What are minimal clinically important differences for patient-reported outcome measures after surgery for cervical spondylotic myelopathy? A 5-year Spine CORe\u2122 analysis of QOD data"],"prefix":"10.3171","volume":"60","author":[{"given":"Connor","family":"Berlin","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maliya","family":"Delawan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Chicago, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina-Mihaela","family":"Matache","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Chicago, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Luc K.","family":"Kabangu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Tennessee Health Science Center, Semmes Murphey Clinic, Memphis, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dayton","family":"Grogan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gracie","family":"Garcia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew K.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Columbia University, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Columbia University, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai-Ming","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Weill Cornell Medicine, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica F.","family":"Bisson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oren N.","family":"Gottfried","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony L.","family":"Asher","sequence":"additional","affiliation":[{"name":"Carolina Neurosurgery & Spine Associates, Carolinas Medical Center, Charlotte, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Kim","sequence":"additional","affiliation":[{"name":"Carolina Neurosurgery & Spine Associates, Carolinas Medical Center, Charlotte, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domagoj","family":"Coric","sequence":"additional","affiliation":[{"name":"Carolina Neurosurgery & Spine Associates, Carolinas Medical Center, Charlotte, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric A.","family":"Potts","sequence":"additional","affiliation":[{"name":"Goodman Campbell Brain and Spine, Carmel, Indiana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent J.","family":"Alentado","sequence":"additional","affiliation":[{"name":"Goodman Campbell Brain and Spine, Carmel, Indiana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin T.","family":"Foley","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Tennessee Health Science Center, Semmes Murphey Clinic, Memphis, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Y.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Virk","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Weill Cornell Medicine, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J.","family":"Knightly","sequence":"additional","affiliation":[{"name":"Maxim Spine, Morristown, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Meyer","sequence":"additional","affiliation":[{"name":"Maxim Spine, Morristown, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheerag D.","family":"Upadhyaya","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis M.","family":"Tumial\u00e1n","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay D.","family":"Turner","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Uribe","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regis W.","family":"Haid","sequence":"additional","affiliation":[{"name":"Atlanta Brain and Spine Care, Atlanta, Georgia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy J.","family":"Yee","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Michigan Health, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Po","family":"Yen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Bydon","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Chicago, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Tennessee Health Science Center, Semmes Murphey Clinic, Memphis, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"J Am Board Fam Med","first-page":"303","article-title":"Cervical spondylotic myelopathy: a guide to diagnosis and management","volume":"33","author":"McCormick 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Cervical spondylotic myelopathy: a guide to diagnosis and management. J Am Board Fam Med. 2020;33(2):303\u2013313. doi:10.3122\/jabfm.2020.02.190195"},{"issue":"1","key":"b2","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Defining cervical spondylotic myelopathy surgical endotypes using comorbidity clustering: a Quality Outcomes Database cervical spondylotic myelopathy study","volume":"59","author":"Yang E","year":"2025","unstructured":"Yang E, Howell H, Mummaneni PV,  Defining cervical spondylotic myelopathy surgical endotypes using comorbidity clustering: a Quality Outcomes Database cervical spondylotic myelopathy study. 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J Neurosurg Spine. 2023;38(1):42\u201355. doi:10.3171\/2022.6.SPINE22110"},{"key":"b9","series-title":"World Neurosurg","first-page":"e436","article-title":"Differences in patient-reported outcomes between anterior and posterior approaches for treatment of cervical spondylotic myelopathy: a Quality Outcomes Database analysis","volume":"160","author":"Wilkerson CG","year":"2022","unstructured":"Wilkerson CG, Sherrod BA, Alvi MA,  Differences in patient-reported outcomes between anterior and posterior approaches for treatment of cervical spondylotic myelopathy: a Quality Outcomes Database analysis. World Neurosurg. 2022;160:e436\u2013e441. doi:10.1016\/j.wneu.2022.01.049"},{"issue":"4","key":"b10","series-title":"Clin Spine Surg","first-page":"188","article-title":"Is upper extremity or lower extremity function more important for patient satisfaction? 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Clin Neurol Neurosurg. 2025;254:108916. doi:10.1016\/j.clineuro.2025.108916"},{"issue":"4","key":"b12","series-title":"J Neurosurg Spine","first-page":"453","article-title":"What predicts the best 24-month outcomes following surgery for cervical spondylotic myelopathy? A QOD prospective registry study","volume":"40","author":"Chan AK","year":"2024","unstructured":"Chan AK, Park C, Shaffrey CI,  What predicts the best 24-month outcomes following surgery for cervical spondylotic myelopathy? A QOD prospective registry study. 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Minimum clinically important difference in patients undergoing minimally invasive transforaminal lumbar interbody fusion. Neurosurgery. 2023;92(6):1199\u20131207. doi:10.1227\/neu.0000000000002350"},{"issue":"7","key":"b24","series-title":"Eur Spine J","first-page":"2794","article-title":"Calculation of the minimal clinically important difference in operated patients with adult spine deformity: advantages of the ROC method and significance of prevalence in threshold selection","volume":"33","author":"Larrieu D","year":"2024","unstructured":"Larrieu D, Baroncini A, Bourghli A,  Calculation of the minimal clinically important difference in operated patients with adult spine deformity: advantages of the ROC method and significance of prevalence in threshold selection. Eur Spine J. 2024;33(7):2794\u20132803. doi:10.1007\/s00586-024-08339-x"},{"issue":"9","key":"b25","series-title":"Eur Spine J","first-page":"3388","article-title":"Calculation of the minimum clinically important difference (MCID) using different methodologies: case study and practical guide","volume":"33","author":"Klukowska AM","year":"2024","unstructured":"Klukowska AM, Vandertop WP, Schr\u00f6der ML, Staartjes VE. Calculation of the minimum clinically important difference (MCID) using different methodologies: case study and practical guide. Eur Spine J. 2024;33(9):3388\u20133400. doi:10.1007\/s00586-024-08369-5"},{"issue":"9","key":"b26","series-title":"Spine J","first-page":"1323","article-title":"Determining minimal clinically important difference estimates following surgery for degenerative conditions of the lumbar spine: analysis of the Canadian Spine Outcomes and Research Network (CSORN) registry","volume":"23","author":"Power JD","year":"2023","unstructured":"Power JD, Perruccio AV, Canizares M,  Determining minimal clinically important difference estimates following surgery for degenerative conditions of the lumbar spine: analysis of the Canadian Spine Outcomes and Research Network (CSORN) registry. 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Eur Spine J. 2025;34(3):1107\u20131114. doi:10.1007\/s00586-024-08582-2"},{"key":"b28","series-title":"Neurosurgery","article-title":"Using the QOD to identify minimum clinically important differences for patients with cervical spondylotic myelopathy","author":"Asher AL","unstructured":"Asher AL, Lakomkin N, Mummaneni PV,  Using the QOD to identify minimum clinically important differences for patients with cervical spondylotic myelopathy. Neurosurgery. Published online January 9, 2026. doi:10.1227\/neu.0000000000003902"},{"issue":"5","key":"b29","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Greater improvement in Neck Disability Index scores in women after surgery for cervical myelopathy: an analysis of the Quality Outcomes Database","volume":"55","author":"Patel A","year":"2023","unstructured":"Patel A, Kondapavulur S, Umbach G,  Greater improvement in Neck Disability Index scores in women after surgery for cervical myelopathy: an analysis of the Quality Outcomes Database. 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