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Peter D. Angevine and Paul C. McCormick

Lumbar discectomy is generally performed to reduce pain or disability and thereby improve quality of life. Important surgery-related results, therefore, include the patients' perceptions of the effect of surgery on their health and ability to perform daily tasks. Spine surgeons should have an understanding of basic concepts of outcome measurement and be able to select appropriate questionnaires and incorporate them into their clinical practices and research. A brief review of the fundamental principles of outcome research is presented, and the recent lumbar discectomy literature concerning these ideas is summarized. Properly designed, conducted, and reported outcome studies of lumbar discectomy will assist the spine surgeon in selecting appropriate patients for surgery, educating them regarding expected results, and comparing this procedure with novel treatments for lumbar disc disease.

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Neurosurgical Forum: Letters to the Editor To The Readership 1150 1152 The National Institute of Arthritis and Musculoskeletal Diseases (NIAMS) announced the funding of a 5-year $13.5 million multicenter study called the Spine Patient Outcomes Research Trial (SPORT) under the direction of James N. Weinstein, D.O., of the Dartmouth Spine Center. It is theoretically designed to evaluate treatment of three disorders, herniated lumbar disc (HLD), spinal stenosis (SS), and degenerative spondylolisthesis (DS). The need for a study to

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Laura P. D'Arcy and Eugene C. Rich

historical changes in the definition and funding of CER, the article explores the mission, priorities, and research agenda of the Patient-Centered Outcomes Research Institute (PCORI), which is an independent, nonprofit corporation established in 2010 by the Patient Protection and Affordable Care Act (ACA). Evolving Conceptions of CER Researchers who systematically review the clinical literature have recognized for decades the need for better evidence regarding “what works best for whom” in health care, but the specific terminology regarding CER has evolved as policy

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Paul C. McCormick

Carragee E : Surgical treatment of lumbar disk disorders . JAMA 296 : 2485 – 2487 , 2006 5 CBS : Is surgery best way to stop back pain? New major study suggests sometimes people are too quick with procedure . CBS Evening News November 21 2006 . ( http://www.cbsnews.com/stories/2006/11/21/eveningnews/main2204297.shtml ) [Accessed 21 March 2007] 6 Dunsker SB , Awad IA , McCormick PC : Spine patient outcomes research trial . J Neurosurg 98 : 1150 – 1152 , 2003 7 Groch J : For herniated lumbar disk, medical therapy matches surgery . Medpage

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Nicholas F. Marko and Robert J. Weil

conclusions. Recent legislation essentially guarantees that safe CER is the type that will be pursued in the US. Congress enacted legislation to create the Patient-Centered Outcomes Research Institute (PCORI) as the nation's de facto CER entity, and then specifically prohibited PCORI from using “…dollars-per-quality adjusted life year (or similar measure…) as a threshold to establish what type of health care is cost effective or recommended.” 10 Any latitude that might have been found in this definition has been eliminated by PCORI Executive Director Joe Selby, who

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Clinical outcomes research in spine surgery: what are appropriate follow-up times?

Presented at the 2018 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Oliver G. S. Ayling, Tamir Ailon, Greg McIntosh, Alex Soroceanu, Hamilton Hall, Andrew Nataraj, Christopher S. Bailey, Sean Christie, Alexandra Stratton, Henry Ahn, Michael Johnson, Jerome Paquet, Kenneth Thomas, Neil Manson, Y. Raja Rampersaud and Charles G. Fisher

recovery plateau at 3 months, regardless of the pathology. We also demonstrated that patients undergoing fusion for LSS and LDS plateaued at 1 year on measures of physical function, compared to 3 months in those without fusion. Findings in the current study are supported by previous results from the Spine Patient Outcomes Research Trials (SPORTs). 16 , 18 , 19 Although the original intent of these trials was not to assess the timing of recovery, investigators found that PROs after lumbar spine surgery for LDH, LSS, and LDS plateaued before 2 years postoperatively

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Dueng-Yuan Hueng, Chia-Lin Tsai, Shih-Wei Hsu and Hsin-I Ma

clinical medicine and public policy. The purpose of this study was to investigate publication patterns of CER in spine neurosurgery. Methods A comprehensive computer search of the PubMed database was performed to identify articles in the field of “comparative effectiveness research” that had been published in peer-reviewed journals between 1980 and April 9, 2012. The initial search terms included either the single term “comparative effectiveness research” or multiple combinations of “cost analysis,” “utility analysis,” “cost-utility,” “outcomes research

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Jefferson R. Wilson, Paul M. Arnold, Anoushka Singh, Sukhvinder Kalsi-Ryan and Michael G. Fehlings

distress syndrome: a randomized controlled trial . JAMA 280 : 159 – 165 , 1998 23 Meyers AR , Andresen EM , Hagglund KJ : A model of outcomes research: spinal cord injury . Arch Phys Med Rehabil 81 : 12 Suppl 2 S81 – S90 , 2000 24 Noreau L , Proulx P , Gagnon L , Drolet M , Laramée MT : Secondary impairments after spinal cord injury: a population-based study . Am J Phys Med Rehabil 79 : 526 – 535 , 2000 25 Pickett GE , Campos-Benitez M , Keller JL , Duggal N : Epidemiology of traumatic spinal cord injury in Canada

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Edward D. McCoul, Vijay K. Anand and Theodore H. Schwartz

ESBS outcomes with those in more standard open and microscope-based approaches. However, recent interest in outcomes research has illuminated our understanding of the importance of patients' perceptions of their state of well-being and the success of a surgical intervention. Analyzing these outcome measures requires the use of valid, standardized assessment tools. Options for assessing these subjective parameters include directed questioning, symptom scores, and QOL measures. Quality of life is a multidimensional construct that describes an individual's overall

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Edward D. McCoul, Jeffrey C. Bedrosian, Olga Akselrod, Vijay K. Anand and Theodore H. Schwartz

in outcomes research has highlighted the importance of patient perception in determining the success of a surgical intervention, particularly when the disease is nonmalignant. A surgeon’s impression of a patient’s well-being following skull base surgery has been shown to be inaccurate, 8 which demonstrates the need for validated, patient-reported assessments of QOL. Instruments that measure QOL can either be generalized or be disease- or site-specific and are typically multidimensional. A limited number of studies have sought to examine the effect of endoscopic