Clinical score description.
| Fusion | Arthroplasty | ||||
| Description | Scoring | Description | Scoring | ||
| Indication | Commonly performed in degenerative conditions such as: intervertebral disc disease degenerative scoliosis spinal canal stenosis20,21 | Mentions one degenerative condition | Indication | Primary indication: isolated discogenic low back pain without instability in a skeletally mature patient, and no more than a grade I spondylolisthesis12,22 Broadened indications: patients with prior surgery, such as microdiscectomy, prior fusion with ASD, and disc replacement below a previous long-segment fusion for scoliosis23,24 | Mentions the primary indication. May mention broadened indications but must not mention inappropriate indications |
| Sometimes performed in lumbar fusion is used for spondylolisthesis, traumatic conditions (fractures and dislocations), tumors (most commonly metastases)21 | Mentions one | Other indications23,24 | Mentions that other indications are unproven | ||
| Alternatives | Nonoperative management21 | Mentions at least two nonoperative options | Alternatives | Nonoperative management21 | Same as fusion marking |
| Other operative management21 | Mentions one other operative management | Operative management13,21,25 | Mentions other operative managements (eg, fusion) | ||
| Procedure | Approaches to the lumbar spine21 | Mentions the existence of other approaches | Procedure | Approach21 | Mentions anterior approach |
| Types of fusion26 | Mentions the existence of other types of fusion | Implant21,27 | Describes the basic structure or function of any implant | ||
| Complications | Major complications 28,29: mortality, neurological deficit, DVT/PE, vascular injury, stroke, deep wound infection | Mentions four major complications, including mortality and neurological deficit | Complications | Major complications (see fusion)13,28,29 | Same as fusion marking |
| Minor complications: 28,29 dural tear, misplaced screw causing radicular pain, UTI, superficial wound infection, postoperative anemia, ileus hematoma/seroma, pseudarthrosis, postoperative pain, adjacent segment disease | Mentions any 4 | Minor complications (see fusion)13,28,29 | Same as fusion marking | ||
| Outcomes | Hospital stay: 2–6 d25 | Mentions an accurate hospital stay | Outcomes | Hospital stay: 2–4 d25 | Mentions appropriate hospital stay |
| Satisfaction rates: 21,30,31 "clinical success" 41%, satisfied—80 % unless on "workers comp" then closer to 50 % | Mentions an accurate figure | Satisfaction rates:21,27 53 % clinical success per FDA criteria for pro-disc L, otherwise as per fusion success rates | Mentions appropriate satisfaction rates | ||
| Recovery: 32 4–6 wk to return to an office or sedentary job, 3 mo or longer to return to activities that are more physical | Mentions accurate recovery times | Recovery: around 3 mo33 | Mentions appropriate recovery times, same as fusion accepted | ||
Clinical score marking rubric. Marking criteria based on clinical evidence (references provided) and set at the standard expected for a patient’s informed consent.
ASD, adjacent segment disease; DVT, deep vein thrombosis; FDA, Food and Drug Administration; PE, pulmonary embolism; UTI, urinary tract infection.