In Reply We thank Rigoard et al for their interest in our article1 and acknowledging our intention to provide clinicians and patients with better information to make surgical decisions using our lumbar fusion surgery calculator (https://becertain.shinyapps.io/lumbar_fusion_calculator). The concerns about poorly specified indications for spine surgery among patients who received surgery are worthy of discussion. Distinguishing symptoms and signs and correlating them with pathology is a worthwhile consideration in making spine surgical decisions but does not reflect common practice. Our study took advantage of the Washington State Spine Surgical Care and Outcomes Assessment Program database, which was created using extracted data from medical records, often seen as the criterion standard for classifying surgical indications in lumbar surgery.2 The taxonomy in the database reflects what is typically used in practice in Washington and arguably across the nation. While we agree that indications, diagnoses, and classifications should be better described, better defined, and more granular in clinical records, the taxonomy used in our study may be representative of actual practice. In spine care, the diagnosis is typically solely described by the surgeon, which, as mentioned in the Limitations section of our article,1 has potential for bias. There is little information relating radiographic features of the spine to symptoms after surgery. To better understand this, we are currently conducting a study that looks at radiographic features at baseline that are associated with function improvement among patients undergoing lumbar fusion.
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Khor S, Flum DR. Questioning Prediction of Lumbar Spine Surgery Outcome—Why We Need to Pay Attention—Reply. JAMA Surg. 2018;153(11):1062–1063. doi:10.1001/jamasurg.2018.2503
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