This is the current release of the guideline.

The grades of recommendations (standards, guidelines, and options) and classes of evidence (I–III) are defined at the end of the "Major Recommendations" field.

Standards. It is recommended that functional outcome be measured in patients treated for low-back pain due to degenerative disease of the lumbar spine by using reliable, valid, and responsive scales. Examples of these scales in the low-back pain population include the following: The Spinal Stenosis Survey of Stucki, Waddell–Main Questionnaire, Roland-Morris Disability Questionnaire (RMDQ), Dallas Pain Questionnaire (DPQ), Quebec Pain Disability Scale (QPDS), Sickness Impact Profile (SIP), Million Scale, Low Back Pain Rating (LBPR) Scale, Oswestry Disability Index (ODI), the Short Form–12, the Japanese Orthopaedic Association (JOA) system, the Curtain Back Screening Questionnaire (CBSQ), and the North American Spine Society Lumbar Spine Outcome Assessment Instrument.

Guidelines. There is insufficient evidence to recommend a guideline for assessment of functional outcome following fusion for lumbar degenerative disease.

Options. Patient satisfaction scales are recommended for use as outcome measures in retrospective case series, where better alternatives are not available. Patient satisfaction scales are not reliable for the assessment of outcome following intervention for low-back pain.

Summary

Functional disability secondary to acute low-back pain, chronic low-back pain, lumbar stenosis, and lumbar disc disease may be reliably and validly assessed using functional outcome surveys that are valid, reliable, and responsive. Outcome instruments supported by Class I and Class II medical evidence for the evaluation of low-back pain include the Spinal Stenosis Survey of Stucki, Waddell-Main, Roland-Morris Disability Questionnaire, Dallas Pain Questionnaire, Quebec Pain Disability Scale, Sickness Impact Profile, Million Scale, Low Back Pain Rating Scale, Oswestry Disability Index, and the Curtain Back Screening Questionnaire. Many of these outcome measures have been applied to patients who have been treated with lumbar fusion for degenerative lumbar disease and have proven to be valid and responsive; however, the reliability of these instruments has never been specifically assessed in the lumbar fusion patient population. Patient satisfaction surveys have been used to measure outcome following lumbar fusion. Their usefulness resides in their insight into patient attitudes toward the treatment experience but is limited because of their inability to measure responsiveness and the lack of information on their reliability.

Definitions:

Grades of Recommendation

Standards Recommendations of the strongest type, based on Class I evidence reflecting a high degree of clinical certainty

Guidelines Recommendations based on Class II evidence reflecting a moderate degree of clinical certainty

Options Recommendations based on Class III evidence reflecting unclear clinical certainty

Classes of Evidence

Class I Evidence from one or more well-designed, randomized controlled clinical trials, including overviews of such trials

Class II Evidence from one or more well-designed comparative clinical studies, such as nonrandomized cohort studies, case-control studies, and other comparable studies, including less well-designed randomized controlled trials

Class III Evidence from case series, comparative studies with historical controls, case reports, and expert opinion as well as significantly flawed randomized controlled trials

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Not applicable: The guideline was not adapted from another source.

2005 Jun

American Association of Neurological Surgeons - Medical Specialty Society
Congress of Neurological Surgeons - Professional Association

This project was funded entirely by a grant from AANS/CNS Section on Disorders of the Spine. No funding was received from any commercial entity to support the production or publication of these guidelines.

Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons (CNS)

Primary Authors: Daniel K. Resnick, MD; Tanvir F. Choudhri, MD; Andrew T. Dailey, MD; Michael W. Groff, MD; Larry Khoo, MD; Paul G. Matz, MD; Praveen Mummaneni, MD; William C. Watters III, MD; Jeffery Wang, MD; Beverly C. Walters, MD, MPH; Mark N. Hadley, MD

Not stated

North American Spine Society - Medical Specialty Society

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI on January 4, 2007. The information was verified by the guideline developer on January 29, 2007.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.