Spinal Disease

Center for Spine Health

The Center for Spine Health is an interdisciplinary, multispecialty group that provides comprehensive care for spine-related disorders. The center’s goals include accurate diagnosis of all spine disorders, return to function, and measurement of patient-reported outcomes. An ongoing focus on outcomes has brought changes to the center through analysis of performance, quality, and cost. These outcomes represent ongoing efforts to standardize care around best practices to provide maximum patient benefit at minimal cost to patients and the health system.

The center offers a full continuum of care including medical management, physical therapy, pharmacologic interventions, image-guided spine procedures, surgical interventions, acupuncture, osteopathic manipulation, specialized exercise programs, and a functional restoration program for chronic pain. The center consists of board-certified neurosurgeons, orthopedic surgeons, spine-medicine specialists, physical medicine and rehabilitation specialists, rheumatologists, internists, neurologists, advanced practice providers, and psychologists.

Surgical Outcomes Across Spinal Procedures

Chart: ACD = anterior cervical discectomy, A/L LIF = anterior/lateral lumbar interbody fusion, CDA = cervical disc arthoplasty, CL and F = cervical laminectomy and fusion, CL = cervical laminoplasty, CPF = cervical posterior foraminotomy, LL = lumbar laminectomy, LM = lumbar microdiscectomy, PLF = post lumbar fusion.

PROMIS - Patient-Reported Outcomes Measurement Information System.

ACD = anterior cervical discectomy, A/L LIF = anterior/lateral lumbar interbody fusion, CDA = cervical disc arthoplasty, CL and F = cervical laminectomy and fusion, CL = cervical laminoplasty, CPF = cervical posterior foraminotomy, LL = lumbar laminectomy, LM = lumbar microdiscectomy, PLF = post lumbar fusion.

Surgical outcomes across various spine procedures have been closely monitored using several performance metrics to evaluate patient recovery and success in patients with severe decline in quality of life. The main metrics include:

  • Return to Usual Activity: across multiple spine surgery types, the percentage of patients who return to their usual activities varies but is generally above 60%. Procedures such as anterior lumbar interbody fusion have some of the highest success rates.
  • Return to Work: return to work rates are similar, with the highest percentages found in anterior cervical discectomy and fusion (ACDF) and lumbar fusion procedures, ranging between 70-85%.
  • Reaching PROMIS Physical MCID: PROMIS physical health outcomes show over 80% of patients reach the minimally clinically important difference (MCID) in physical health scores following lumbar and cervical surgeries.
  • Reaching mJOA MCID: for patients with myelopathy, reaching the MCID for the modified Japanese Orthopaedic Association (mJOA) score typically ranges between 50-70%, depending on the specific surgical procedure.
Resource Utilization in Spine Healthcare

ACD = anterior cervical discectomy, CL = cervical laminoplasty, CPF = cervical posterior foraminotomy, LL = lumbar laminectomy, LM = lumbar microdiscectomy.

Across all spine surgeries throughout the enterprise, including cervical, thoracic, and lumbar, only 10% of patients are high utilizers of healthcare resources up to one year after surgery while providing premium care for their post-operative care. The utilization of healthcare resources across different spine surgeries reveals key patterns:

  • Low utilizers: a notable proportion of patients undergoing anterior cervical discectomy and fusion (ACDF) fall into the low-utilizer category, suggesting these surgeries often require fewer follow-up resources compared to others.
  • Moderate utilizers (with and without advanced imaging): a significant proportion of patients fall into this group, particularly those undergoing lumbar laminectomy and lumbar microdiscectomy. These patients use moderate healthcare resources, with or without the use of advanced imaging modalities.
  • High utilizers: high utilization is more commonly seen in lumbar fusion and laminectomy procedures, where up to 30% of patients require extensive postoperative care and imaging follow-ups.