Published 12/31/2023
Bryce A. Basques, MD

PROMs Are a Vital Measure of Success in Spine Surgery

Editor’s note: This article is part of an ongoing “PROMs in Practice” series presented by the AAOS Patient-Reported Outcome Measures (PROMs) Workgroup. Each month, a workgroup member will address the impact of PROMs on their subspecialty, patient care, the future of musculoskeletal healthcare, and more.

In the field of spine surgery, the ultimate goal is to improve quality of life for patients suffering from debilitating spinal conditions. Traditionally, the success of spinal interventions has been measured by physicians’ clinical and radiological assessments in the office. However, these measures often fail to capture the full impact of surgery on a patient’s life.

PROMs have emerged as a crucial tool in evaluating the effectiveness of spine surgery because they provide insights into the patient’s perspective, enabling surgeons to tailor treatment plans. In the context of spine surgery, PROMs encompass a wide range of measurements, including pain, physical function, emotional well-being, and overall satisfaction with the treatment, and they allow spine surgeons to track changes in a patient’s condition over time.

Importance of PROMs in spine surgery
PROMs serve several purposes in the context of spine surgery.

1. Holistic assessment of patient health
One of the primary advantages of PROMs in spine surgery is their ability to provide a more comprehensive picture of a patient’s health. Whereas clinical and radiological assessments focus on specific physical aspects, PROMs capture the patient’s subjective experience, including pain, ability to perform daily activities, and psychological well-being. This approach allows surgeons to better understand the overall impact of a spinal condition and its treatment on the patient’s life.

2. Personalized treatment plans
PROMs empower surgeons to tailor treatment plans to meet the unique needs of each patient. By assessing PROMs before surgery, surgeons can identify specific areas of concern and prioritize interventions accordingly. PROMs enable surgeons to conduct effective conversations and shared decision making to better understand a patient’s perspective and priorities, allowing for care that is tailored to individual needs. In spine surgery, where treatment options can vary greatly, understanding what matters most to the patient is essential in making informed decisions.

3. Long-term progress monitoring
Spine surgery is not a one-time event; depending on the approach, it can involve a prolonged recovery process and sometimes subsequent operations. PROMs are valuable tools for monitoring a patient’s progress over time. By regularly collecting PROM data after surgery, surgeons can identify complications or changes in a patient’s condition promptly, beyond what can be directly assessed in the office. This proactive approach enables early intervention and prevents potential setbacks in the recovery process.

4. Benchmarking and quality improvement
PROMs provide a standardized way to benchmark the outcomes of different surgical techniques and interventions. By comparing PROM data across different treatment modalities, surgeons can identify which approaches yield the best outcomes. This information, which can be collected through a national registry program such as the American Spine Registry, informs evidence-based decision making and drives improvements in spine surgery techniques and protocols.

5. Enhanced doctor-patient communication
Effective communication between surgeons and patients is paramount in spine surgery. PROM questionnaires encourage patients to express their concerns and expectations, fostering open and transparent dialogue. This improved communication allows surgeons to set realistic expectations, address patients’ fears and anxieties, and build trust, which can positively influence patients’ overall satisfaction.

Common PROMs
Several PROM questionnaires are commonly used in spine surgery to assess different aspects of a patient’s health and well-being:

  • Visual analog scale: This simple scale allows patients to rate their pain intensity on a scale of 0 to 10, with 0 indicating no pain and 10 indicating the worst pain imaginable. This tool is commonly used for neck pain, arm pain, back pain, and leg pain.
  • Oswestry Disability Index (ODI)*: This questionnaire assesses the impact of low-back pain on a patient’s daily life, measuring functional limitations in various activities.
  • Neck Disability Index (NDI)*: Similar to the ODI but focused on the cervical spine, the NDI assesses the impact of neck pain on daily activities and functioning. It includes 10 questions related to neck pain and its consequences.
  • Scoliosis Research Society-22 (SRS-22) Questionnaire: The SRS-22 is designed for patients with scoliosis. It assesses pain, function, self-image, and satisfaction with treatment. It includes 22 questions and helps monitor scoliosis-related outcomes.
  • PROMIS (Patient-Reported Outcomes Measurement Information System)*: PROMIS is a collection of standardized measures that assess various aspects of physical, mental, and social health. It includes a range of questionnaires to tailor assessments to specific conditions or outcomes.

PROMs have revolutionized the evaluation of spine surgery outcomes by providing a patient-centered perspective on treatment success. They offer a holistic view of a patient’s health, enable personalized treatment plans, facilitate long-term monitoring, support objective benchmarking, and enhance doctor-patient communication. Ultimately, the integration of PROMs into spine surgery practice leads to better-informed decisions, improved patient care, and higher patient satisfaction. As healthcare continues to evolve, PROMs will remain a vital tool in advancing the field of spine surgery and ensuring that patients receive the best possible care and outcomes.

* The American Spine Registry, a collaborative registry between the American Association of Neurological Surgeons and AAOS, utilizes these instruments in its registry.

Resources developed by the PROMs Workgroup will be announced to AAOS membership as they are released and can be found at aaos.org/proms. For more information or to get involved, email proms@aaos.org.

Bryce Basques, MD, is an assistant professor and the director of minimally invasive spine surgery at the Warren Alpert School of Medicine of Brown University. He is a member of the AAOS PROMs Workgroup and the AAOS Committee on Evidence-Based Quality and Value.