No pain; no restriction of activity
Occasional pain of sufficient severity to interfere with the patient's ability to do his normal work or his capacity to enjoy himself in leisure hours
Improved functional capacity, but handicapped by intermittent pain of sufficient severity to curtail or modify work or leisure activities
No improvement or insufficient improvement to enable increase in activities; further operative intervention required
Macnab I. “negative disc exploration: an analysis of the cause of nerve root involvement in sixty-eight patients.” J Bone Joint Surg (Am) 1971 ;53:891-903
Ahn Y, Lee SH, Chung SE, Park HS, Shin SW. Percutaneous endoscopic cervical discectomy for discogenic cervical headache due to soft disc herniation. Neuroradiology 2005; 47:924-930
Name and Synonyms
Macnab criteria, MacNab's outcome assessment of patient satisfaction
Structure / Content
The patient is asked to rate his level of well-being, generally after surgery. The patient choose one of the four: Excellent, Good, Fair, Poor. With the the same wording with the original (source) paper, the explanations of each grade are as follows:
There is Modified Macnab Criteria. It is quite difficult who have modified the instrument and when it has been done. 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:
It is free. Usage is common due to simplicity.
Scientific Spine's Comment
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.
Scottish-origin Canadian orthopedic surgeon and scholar (1921-1992). In the spine area, Ian Macnab is well known for his researchs and publications on low back pain and the outcome instrument Macnab criteria. Ian Macnab made outstanding contributions as researcher, teacher, and orthopaedic surgeon.
Ian was the son of a Scottish shipbuilder who was living in India. When Ian was five years old, his parents sent him home to Britain to receive an education in an English boarding school. He attended medical school at the University of Birmingham, graduating with first class honors. After a residency in general and orthopaedic surgery, he served in the Royal Army Medical Corps, from 1445 to 1947. He then completed his orthopaedic training at Ihe Royal National Orthopaedic Hospital in London. He became interested in low back disability. With the recommendation of Sir Herbert Seddon, he went lo Toronto in 1950, to study the pathogenesis of low back pain, as a research fellow at the Banting Institute with Dr. R. I. Harris. He established a university orthopaedic service at the Toronto General Hospital. Ian Macnab acquired a passionate devotion and pride for his adopted country, for Toronto, and for its orthopaedic service. He was appointed Professor of Orthopaedic Surgery at the University of Toronto and Chief of the Orthopaedic service at the Wellesley Hospital.
His range of academic interests was wide. Although he was internationally renowned as a spine surgeon, his most famous contributions are probably his studies on the pathogenesis of low back pain. He also had expertise in the areas of hallux rigidus, patellar dislocation, opponens transfer, whiplash injuries, pathological changes in the neurocentral joints of the cervical spine, lesions of the menisci, anterior tibial compartment syndrome, the effect on osteogenesis of alternating currents in bone, blood supply of the vertebral bodies and the femoral head, the reaction of body tissues to ceramics, the microcirculation of the rotator cuff, and shoulder arthroplasty.
As a teacher Dr. Macnab was unsurpassed. To North Americans, his knowledge and expertise, combined with his command of the English language and his Churchilhan oratory, made him one of the most sought-after orthopaedic lecturers and visiting professors. In his classic 1977 Presidential Address "Seek and Ye Shall find" he stated "You do not have to be a trained investigator lo discover. You must, however, preserve your sense of wonder, your ability to be astonished and you must be sure that your brain remains connected to your retina so that you will not only see, but you will also perceive... Research is just not a laboratory activity. More importantly, it is an attitude of mind. Every surgeon must recognize his own potential in this regard and not be content to Ieave advances to others. Seek and ye shall find".