• Vincent J Alentado, Stephanie Caldwell, Heath P Gould, Michael P Steinmetz, Edward C Benzel, and Thomas E Mroz.
• Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA.
• Spine J. 2017 Feb 1; 17 (2): 236-243.

Background ContextMultiple studies have determined minimum clinically important difference (MCID) thresholds for EuroQOL-5 Dimensions (EQ-5D) scores in lumbar fusion patients. However, a comprehensive understanding of predictors for a clinically significant improvement (CSI) postoperatively does not exist.PurposeTo determine medical, radiographic, and surgical predictors for obtaining a CSI following lumbar fusion surgery.Study DesignThis is a retrospective review of patients who underwent instrumented lumbar fusion.Patient SampleWe included patients who underwent lumbar fusion for any indication between 2008 and 2013.Outcome MeasuresOutcome measures included preoperative and postoperative EQ-5D Index scores.Materials And MethodsThe medical records of patients who received a lumbar fusion for any indication were retrospectively reviewed to identify patient medical and surgical characteristics. A blinded reviewer assessed radiographs for each patient to examine sagittal alignment following fusion. Multivariable logistic regression was used to model the achievement of a CSI based on two commonly cited MCID values.ResultsA total of 231 patients fit the inclusion criteria; 58% exceeded an MCID value for an EQ-5D score of 0.100, and 16% exceeded an MCID value of 0.390. Statistically significant independent predictors of not obtaining a CSI for an MCID threshold of 0.100 included a higher preoperative EQ-5D score (odds ratio [OR]=44.8) and L5-S1 fusion (OR=3.3). For an MCID value of 0.390, a higher preoperative EQ-5D score (OR=2,080.8) and a diagnosis of depression (OR=7.1) were predictive of not achieving a CSI, whereas spondylolisthesis (OR=4.1) was predictive of obtaining a CSI postoperatively. For both MCID values, patients who achieved a CSI had better postoperative quality of life (QOL) scores for all metrics measured, despite worse QOL scores preoperatively.ConclusionsThis study is the first to use a combination of medical, surgical, and postoperative sagittal balance variables as determinants for the achievement of a CSI after lumbar fusion. The awareness of these predictors may allow for better patient selection and surgical approach to decrease the probability of acquiring a poor outcome postoperatively.Copyright © 2016 Elsevier Inc. All rights reserved.

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