Amid multiple important data points showing spine surgery success, many physicians find that patient lifestyle is the best sign of strong outcomes.
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. Becker’s invites all spine surgeon and specialist responses.
Next question: How has your threshold for recommending surgery changed over the last five years?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, Feb. 3.
Editor’s note: Responses were lightly edited for clarity.
Question: What outcome metric do you trust the most when evaluating whether a spine procedure was truly successful?
Anthony Ghosh, MD. The Spine Multi-Disciplinary Team (London): While we track many objective measures, such as quality of life and pain scores, the metric I trust most is whether a procedure has a true, very real personal impact on the patient’s daily life.
I’m a big believer in a patient-focused, goal-oriented approach. For me, a procedure is truly successful when a patient can achieve a specific, realistic objective that matters to them, whether that’s playing with their grandkids, going for a walk, getting a full night’s sleep, or going on a holiday.
Often, patients underestimate what they can achieve, and I always encourage them to aim for a bit more than their initial expectations. When they hit those milestones, it provides a profound sense of motivation and joy that benefits not just their physical recovery but also their mental health. Ultimately, success for me is defined by that tangible improvement in their individual quality of life.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: Return to meaningful activities and sustained functional improvement trump everything else. I trust patient-reported outcome measures like ODI and NDI because they reflect what actually matters to patients’ lives. A patient who returns to work, exercises, and engages with family represents success regardless of whether their adjacent segment shows some degeneration or their fusion looks “incomplete” on CT. We were trained to value technical perfection on imaging, and that matters — but not as much as whether someone can live the life they want. The metric I watch most carefully: would the patient choose surgery again knowing what they know now? That question keeps me honest and focused on what I’m actually trying to achieve. Every surgeon I know wants their patients to do well; we just need to be clear about what “doing well” actually means to the people we’re trying to help.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Spine care metrics and outcomes focus on the successes and effectiveness of these interventions and its overall utility and functionality for the receiving patient. The Centers for Medicare/Medicaid Services, spinal societies, (Scoliosis Research Society, NASS) and employed healthcare institutions have common methods for patient reporting. There are 22 measures for Patient Reported Outcome Measures, (PROMs) evaluating the health and function of patients post spinal surgery. Post-operative vigilance and follow-ups for months, if not years, is required for most complex interventions, as subtleties, progress and expectations can be enacted through dialogue and assurance. Functional return, improvements in ambulation and exercise, patient willingness to advance and progress from previous stature and return to work status are trusted, recorded metrics utilized often.
