Modified Macnab Criteria

It is quite difficult to identify who and when modified the instrument. It seems everyone changed the wording for better and more detailed explanation of categories, which are same with the original one (Excellent, Good, Fair, Poor). A common version of this modified scale is below:

Excellent: No pain, No restriction of mobility, Return to normal work and level of activity

Good: Occasional nonradicular pain, Relief of presenting symptoms, Able to return to modified work

Fair: Some improved functional capacity, Still handicapped and/or unemployed

Poor: Continued objective symptoms of root involvement, Additional operative intervention needed at index level irrespective of length of postoperative follow-up

Macnab criteria reflects well a surgeon's impression about the surgery's overall success in terms of patient's satisfaction, and how that particular patient should be categorized. Its roughness (only 4 class, and no detailed metrics of symptomatology) necessiates its use should be accompanied and backed by other scales such as pain scales and ODI, etc. It is still useful. However, its use as a sole outcome instrument is not acceptable in today's standards.