For decades, spine surgery has relied on some of medicine’s highest-quality research. Randomized trials. Prospective studies. Single-center investigations led by academic institutions.
Those studies transformed spine care, but they also came with a limitation: They often reflected ideal conditions rather than everyday practice.
Now, spine surgeons have something they have never had before: scale.
The American Spine Registry, a joint initiative of the American Association of Neurological Surgeons and the American Academy of Orthopaedic Surgeons, has surpassed 600,000 patient cases, making it the largest spine registry in the world. For the first time, spine surgeons can study outcomes across hundreds of institutions, thousands of physicians and virtually every practice setting in the country.
According to Mladen Djurasovic, MD, orthopedic co-chair of the registry and a spine surgeon at Louisville, Ky.-based Norton Leatherman Spine Center, the implications extend far beyond research.
“It gives us the potential to really use large datasets to answer important questions about quality measures, surgical site infections, readmissions and reoperations,” Dr. Djurasovic said. More importantly, he said, the registry provides something traditional clinical trials often cannot: a view of how spine care works in the real world.
“A lot of the smaller studies that spine care has historically been based on had very strict inclusion and exclusion criteria,” he said. “A large-scale registry allows us to see how spine care is being delivered across the country and what outcomes look like in a general population.”
Beyond the academic medical center
One of the registry’s defining features is its structure. Historically, orthopedic surgeons and neurosurgeons have maintained separate research ecosystems despite performing many of the same spine procedures.
The American Spine Registry brings both specialties together under a shared data platform, an effort jointly led by orthopedic and neurosurgical leaders, including Dr. Djurasovic and his neurosurgical counterpart, Mohammed Bydon, MD, chair of neurological surgery at the University of Chicago.
That collaboration allows the registry to capture a broader and more representative picture of spine care than either specialty could generate independently. Today, nearly 460 institutions contribute data. The result is a dataset that spans academic medical centers, community hospitals and ASCs across the country.
For researchers, that scale creates opportunities that were previously impossible. For healthcare leaders, it creates something equally valuable: benchmarks.
Shedding light on complications
Some of the registry’s most prominent findings are already challenging long-held assumptions. One recent analysis examined what happens when spine surgery patients experience complications after leaving the hospital. Many surgeons assume those patients return to the institution where the original procedure was performed. The data suggests otherwise.
“We found that a relatively high percentage of patients actually end up going to a different hospital than where they had their initial surgery,” Dr. Djurasovic said. The finding emerged after researchers combined registry data with CMS claims data, allowing them to track patient encounters that occurred outside participating institutions.
Without those additional datasets, some complications would have remained invisible. The study highlighted a challenge facing nearly every quality registry: Outcomes are only as complete as the data being captured.
“We may have a tendency to underestimate certain things because they’re showing up somewhere that falls outside the registry,” he said. The ability to connect claims data with clinical registry data may ultimately provide a more accurate picture of readmissions, complications and quality metrics across the spine ecosystem.
The next frontier
The registry is also poised to answer one of the most important questions facing spine surgery today: Which procedures can safely move to outpatient settings?
As more spine cases migrate to ASCs, hospitals, surgeons and payers are all seeking evidence to guide patient selection and site-of-care decisions. Until now, most studies comparing outpatient and inpatient spine surgery have been relatively small.
The registry changes that equation.
“We’re going to have a wide variety of practice settings and a huge sample size,” Dr. Djurasovic said. “We’ll be able to get a good sense of the safety profile of procedures performed in surgery centers versus hospitals.”
Procedures such as lumbar discectomy, lumbar laminectomy and anterior cervical discectomy and fusion are expected to be among the first areas of focus. The findings could help shape future reimbursement models, patient selection criteria and value-based care initiatives.
Why payers are paying attention
While the registry was created primarily as a quality-improvement tool, its role in value-based care continues to expand. Participation is increasingly being used to support center-of-excellence designations and demonstrate quality performance to payers.
“I think participation in registries like ASR is going to become very important for both clinicians and institutions,” Dr. Djurasovic said. That does not mean insurers will gain unrestricted access to the data. Dr. Djurasovic emphasized that the registry was designed first and foremost as a physician-led quality improvement initiative rather than a payer oversight tool.
Instead, participating organizations use the data to compare performance against national benchmarks and identify opportunities for improvement. For community hospitals and ASCs, that benchmarking capability may become one of the registry’s most valuable features.
“I think being able to compare your outcomes to national benchmarks has huge value,” he said.
What happens when the data gets smarter
Perhaps the most ambitious phase of the registry is only beginning. The American Spine Registry recently expanded its use of surgeon-completed clinical forms that capture detailed information about patient pathology, surgical indications and procedural decision-making.
Unlike billing codes, which often provide only a partial picture of why a procedure was performed, these forms reflect the surgeon’s actual clinical reasoning.
The goal is to move beyond simple outcome tracking and toward comparative effectiveness research.
In practical terms, that means answering questions spine surgeons debate every day. Which patients with degenerative spondylolisthesis benefit from decompression alone? Which require fusion? When is one fusion technique superior to another? Which procedures deliver the best value?
With hundreds of thousands of cases and increasingly sophisticated clinical data, the registry may soon have the statistical power to answer questions that previously required years of smaller studies.
“We have such big numbers that once we get really good detailed information on the front end, we’ll be able to do high-quality comparisons of which procedures are best for which patients,” Dr. Djurasovic said.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
