This article updates readers on the current state of the Oswestry Disability Index (ODI) and the impact of unvalidated versions. The ODI is now licensed to the Mapi Research Trust in order to preserve a standard version in English and in validated translations. A proposed threshold of "normality" is potentially helpful as an outcome for both audit and research. There is an application of the sex section as a quality measure in Germany. The ODI is an important international shared resource for clinicians and investigators and should not be abused. Its current status will not be enhanced by further modification. It is now registered with the International Consortium for Health Outcomes Measurement as a standard outcome measure.