Name and Synonyms

Macnab criteria, MacNab's outcome assessment of patient satisfaction.

Source Article

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

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:

  • Excellent: No pain; no restriction of activity.
  • Good: Occasional back or leg pain of sufficient severity to interfere with the patient’s ability to do his normal work or his capacity to enjoy himself in his leisure hours.
  • Fair: Improved functional capacity, but handicapped by intermittent pain of sufficient severity to curtail or modify work or leisure activities.
  • Poor: No improvement or insufficient improvement to enable increase in activities; further operative intervention required.


There is 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

Cost and Frequency of Use

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.

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