How PROMs help deliver the 'highest-success' surgeries in spine — 5 surgeon insights


Five spine surgeons discuss patient-reported outcome measures in spine and how they have influenced their practice.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.

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Please send responses to Alan Condon at by 5 p.m. CDT Wednesday, Sept. 9.

Note: The following responses were lightly edited for style and clarity.

Question: Do you use patient-reported outcome measures (PROMs)? If so, how have they affected your practice?

Jeffrey Wang, MD. USC Spine Center (Los Angeles): We use PROMs to confirm how patients are doing with their treatments, and it gives us an idea of how they are progressing compared to others who fit the similar categories or have similar issues and treatments. But overall, where we look for evidence on what to base our treatment recommendations, by pooling all of the patients together, we can gather comparative data on the success of different procedures, according to specifics of each patient. This may ultimately allow us to select the most appropriate and highest-success surgeries for our specific patients. In addition, it allows us to compare the outcomes of new procedures and see how they compare to more traditional techniques.

Todd Lanman, MD. Lanman Spinal Neurosurgery (Beverly Hills, Calif.): We routinely use PROMS. Some of those for the cervical spine are slightly different than those for the lumbar spine, but most cover both. There's the SF-36 form, which has a physical component score and mental composite score. There's the PROMs, the neck disability index, visual analog scales and many other outcome measures that are used in practice.  

We also have patients come in at certain time intervals after surgery, so we have outcome measures or we get a status of the patient's pain and disability levels prior to surgery. Then we repeat these measures and outcomes after surgery at set time intervals, usually at six weeks, 12 weeks, six months, 12 months and then yearly. 

These are really imperative to evaluate how well your different operations or procedures are performing. If one chooses to study the patient or you're involved in a clinical trial with the FDA, patients are required to fill these out. These windows of time need to be maintained adequately and have the same exam performed, with intakes for the surveys taken by the same physician at each visit. This helps give us clinically relevant data outcomes to assess which procedures are more effective and safer for the patient in the long term.

Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): I obtain visual analog scale pain scores, neck disability index scores and Oswestry Low Back Disability scores on all new patients and then collect the same scores periodically and after surgery. This helps me to evaluate the treatment outcomes in a more objective manner. It can also help to demonstrate the value of my care to outside agencies such as health insurance carriers or hospitals.  

Robert Greenleaf, MD. Reconstructive Orthopedics (Sewell, N.J.): I have been using patient-reported outcomes information consistently for about three years. The main effect on my practice has been the ability to provide patients with accurate statistics and expectations to guide them through their decision-making processes. Being able to cite outcomes of my specific patients has been a useful tool.

Brian Gantwerker, MD. Craniospinal Center of Los Angeles: Since my practice's inception, I have used my interviews as my outcomes. I ask three simple questions:  1) Did the surgery help you with your problem? 2) Are you still taking pain pills, and if not, when did you stop? 3) Does your pain wake you up at night anymore?  My PROMs in this case ensure I am doing a decent job.  

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