Developing the total disability index based on an analysis of the interrelationships and limitations of oswestry and neck disability index

Matthew A. Spiegel, Renaud Lafage, Virginie Lafage, Devon Ryan, Bryan Marascalchi, Yuriy Trimba, Christopher Ames, Bradley Harris, Elizabeth Tanzi, Jonathan Oren, Shaleen Vira, Thomas Errico, Frank Schwab, Themistocles S. Protopsaltis

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Study Design. Retrospective. Objective. This study assessed the feasibility of combining Oswestry and Neck Disability Index (ODI and NDI) into 1 shorter Total Disability Index (TDI) from which reconstructed scores could be computed. Summary of Background Data. ODI and NDI are not pure assessments of disability related to back and neck, respectively. Because of similarities/redundancies of questions, ODI scores may be elevated in neck-pain patients and the converse is true for NDI in back-pain patients. Methods. Spine patients completed ODI and NDI, and complaints were recorded as back pain (BP), neck pain (NP), or both (BNP). Questionnaire scores were compared across cohorts via descriptives and Spearman (r) correlations. In exploring the feasibility of merging ODI/NDI, TDI was constructed from 9 ODI and 5 NDI items. Extracting questions from TDI, reconstructed 9-item rODI and 10-item rNDI indices were formed and compared with true ODI/NDI. Results. There were a total of 1207 patients: 741 BP, 134 NP, and 268 BNP. Mean ODI was 37±21 and mean NDI was 32±21. Patients with concurrent BP and NP had significantly more disability. Seventy-eight patients of 134 (58%) patients with NP only had at least moderate disability by ODI and 297 of 741 (40%) patients with back pain only, had at least moderate disability by NDI. ODI versus NDI correlation was r =0.755; ODI versus reconstructed rODI correlated at r=0.985, and NDI versus reconstructed rNDI correlated at r=0.967 (P<0.01). Conclusion. Elevated ODI/NDI scores in patients with isolated complaints show that disability in 1 region affects scores on both surveys. This study constructed a 14-item TDI that represents every domain of ODI/NDI with exception of ODI Sex Life. From this TDI, reconstructed scores correlated near perfectly with true scores. TDI provides a more global assessment of spinal disability and is a questionnaire that reduces the time burden to patients. The TDI allows for simultaneous assessment of back, neck, and global spinal disability.

Original languageEnglish (US)
Pages (from-to)74-81
Number of pages8
Issue number1
StatePublished - 2016
Externally publishedYes


  • Back pain
  • Cervical deformity
  • Health-related quality of life
  • Neck Disability Index
  • Neck pain
  • Oswestry Disability Index
  • Thoracolumbar deformity
  • Total Disability Index

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology


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