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.

在答复中我们感谢Rigoard等人对我们的文章^1的关注并确认我们打算使用我们的腰椎融合手术计算器（https://becertain.shinyapps.io/lumbar_fusion_calculator）为临床医生和患者提供更好的信息，以做出手术决策。接受手术的患者对脊柱手术指征指定不明确的担忧值得讨论。在做出脊柱外科手术决策时，区分症状和体征并将其与病理学联系起来是值得考虑的考虑因素，但并不能反映常规做法。我们的研究利用了华盛顿州脊柱外科手术和结果评估计划数据库，该数据库是使用从病历中提取的数据创建的，通常被视为对腰椎手术适应证进行分类的标准标准。^2个数据库中的分类法反映了华盛顿在实践中和可能在全国范围内通常使用的分类法。尽管我们同意应该在临床记录中更好地描述，更好地定义适应症，明确诊断和分类，并且在临床记录中更细化，但我们的研究中使用的分类法可能代表了实际做法。在脊柱护理中，诊断通常仅由外科医生来描述，正如我们文章的“局限性”部分所述，外科医生¹可能会产生偏见。很少有信息将脊柱的放射学特征与手术后的症状联系起来。为了更好地理解这一点，我们目前正在进行一项研究，该研究在基线时观察与腰椎融合患者的功能改善相关的放射学特征。