Reoperation is the single biggest driver of lost cost-effectiveness in spine surgery, and one University of California San Francisco surgeon-researcher is building a dataset aimed at proving that shorter follow-up windows can still predict long-term success.
Praveen Mummaneni, MD, professor and co-director of the UCSF Spine Center in San Francisco, has spent years tracking outcomes through the Spine Core study group, a 14-site collaborative within what was previously known as the Quality Outcomes Database and is transitioning to the American Spine Registry. The registry has five years of follow-up on more than 6,000 patients across the four most common spine procedures — grade-1 and grade-2 spondylolisthesis, cervical radiculopathy and cervical myelopathy — with an 80% five-year follow-up rate.
That dataset points to a clear culprit when cost-effectiveness breaks down. “Single-level surgery is incredibly cost effective as long as you don’t have to reoperate,” Dr. Mummaneni said. “But the moment you reoperate, your cost-effective number basically drops in the bucket.”
The registry can also identify why a patient was reoperated on — same-level failure, adjacent-level disease or an unrelated cause — giving payers and surgeons a clearer picture of what actually drives downstream costs.
Dr. Mummaneni described reoperation as a cascading failure that touches nearly everyone involved in a patient’s care. Patients face another round of time off work, an extended recovery and dependence on family for basic tasks like driving. Payers absorb a second episode of care on top of the first. And surgeons are left trying to manage an unhappy patient and an unhappy insurer at the same time.
“Everybody’s mad,” he said. “The whole thing is a mess.” That downstream disruption, he said, is exactly why avoiding a second surgery matters as much as executing the first one well.
Dr. Mummaneni, who is pursuing a master’s degree in clinical informatics, is studying whether three-month outcomes can reliably predict five-year results for cost per quality-adjusted life year and incremental cost-effectiveness ratio. He said he hopes to have findings ready by the American Association of Neurological Surgeons’ annual meeting in May 2027 in San Diego. If the correlation holds, it would give surgeons and payers a much faster read on whether a given episode of care is on track for long-term success, rather than waiting years to know.
The question carries direct implications for CMS’ 90-day bundled payment model, which was designed primarily around orthopedic procedures. If short-term data can reliably forecast five-year outcomes, Dr. Mummaneni said, it could strengthen the case for evaluating spine surgery on longer-term value rather than a 90-day window alone — giving physicians a data-backed way to argue that a narrow reimbursement window doesn’t capture the full value or full risk of a procedure.
The findings have also changed how he counsels patients weighing surgery, many of whom arrive skeptical after hearing about friends or family members who needed multiple procedures. Dr. Mummaneni said the five-year data lets him quantify specific quality-of-life improvements that used to be discussed only anecdotally: patients who couldn’t sleep regaining the ability to sleep, patients regaining the ability to drive and resolution of sexual dysfunction tied to their condition.
“Well-executed spine surgery is actually incredibly cost-effective and really helps their quality of life,” he said. “It’s not 100%. It might be 80%, and here’s your chance of doing really well in five years.”
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