Issue link: https://beckershealthcare.uberflip.com/i/1546114
14 ORTHOPEDICS at has changed his sequencing of care. "e No. 1 maneuver is to treat it, not rush off to surgery," he said. "And then maneuver No. 2 is to do the operation." at shi reflects a broader evolution in spine surgery. e operation still matters. But increasingly, outcomes depend on what happens before the incision: optimizing bone health, selecting the right patient, setting realistic expectations and addressing risks that were once underrecognized. Innovation has to be judged over years, not months Dr. Mummaneni also believes the five-year data should shape how the field evaluates technology. Spine surgery has seen major advances in biomaterials, implant design and fixation. ree-dimensional printed cages, improved screw designs and better fusion technologies have changed what surgeons can achieve compared with 10 or 20 years ago. He believes those advances are contributing to fewer revisions. at is especially important as patients live longer aer complex spine surgery, including those with spinal tumors and metastatic disease. In the past, surgeons might not have expected some oncology patients to live long enough for fusion durability to matter. Today, many are surviving five to seven years or longer. at changes the responsibility. "You have to pay attention, is the bone going to heal?" Dr. Mummaneni said. "Otherwise, the implant will fail over time." For him, innovation should not be judged only by whether it improves a postoperative X-ray or shortens a hospital stay. It should be judged by whether it prevents failure years later. at is why long-term registries matter. ey reveal whether technology delivers value beyond the immediate episode of care. e policy problem e stakes of outcomes measurement are rising. CMS and other payers are increasingly moving toward models that shi risk onto surgeons and evaluate performance using standardized metrics. Dr. Mummaneni is concerned some of those measures may not reflect the outcomes spine surgeons actually use or understand. He pointed to FOTO, focus on therapeutic outcomes, an outcome measure he said many spine surgeons do not routinely use. He believes health systems and policymakers should focus on validated measures already used widely in spine research and clinical practice: EQ-5D, Oswestry Disability Index, Neck Disability Index, numeric pain scores, return to work and patient satisfaction. "ese are the ones that actually patients will show the true benefits on," he said. "ese are the ones that spine surgeons use frequently. ese are the ones we're familiar with." e wrong metrics could have real consequences. If surgeons are judged by unfamiliar or poorly understood measures that follow them across hospitals, some may stop taking Medicare patients or avoid operations perceived as risky under the model. "I think surgeons are going to drop out of Medicare, and I think that would be a disaster," Dr. Mummaneni said. He is especially concerned about policies built around the belief that spine surgery is expensive, ineffective or short-lived in its benefits. e five-year data, he said, shows the opposite for many properly selected patients. What value looks like five years later e Quality Outcomes Database was created to establish risk- adjusted benchmarks, measure safety and effectiveness, demonstrate comparative value and help identify which patients are most likely to benefit from specific neurosurgical and spine procedures. Over time, its spine modules evolved into some of the largest North American spine registries, with longitudinal patient-reported outcomes that allow surgeons and health systems to evaluate durability rather than relying only on short-term results. at long-term view is now producing evidence across multiple conditions, including cervical myelopathy, cervical radiculopathy, grade-1 spondylolisthesis and high-grade spondylolisthesis. Across 14 sites, Dr. Mummaneni said researchers now have roughly 6,000 to 7,000 patients with five-year follow-up in major spine datasets. One forthcoming cervical radiculopathy dataset alone includes about 4,400 patients with five-year follow-up at roughly 80%. e size matters. So does the follow-up. Spine surgery has oen been judged by cost, complication rates and isolated short-term outcomes. e QOD allows researchers to examine return to work, opioid discontinuation, pain, disability, quality of life and patient satisfaction over years. at provides a more complete definition of value. For example, if surgery helps a patient return to work and remain functional for years, the value cannot be measured only by the initial price of the operation. Dr. Mummaneni said researchers are now using measures such as EQ-5D to calculate quality-adjusted life years, incremental cost- effectiveness ratios and other analyses designed to show the long-term economic value of spine care. e conclusion, he believes, is clear. Spine surgery is not simply expensive. In properly selected patients, it can be cost-effective. e next era of spine data e registry is still teaching surgeons things they did not know. at is the point. Dr. Mummaneni said the data has already changed how he talks to patients, how he evaluates risk factors, how he thinks about minimally invasive surgery and how he prepares patients with osteoporosis before fusion. He believes the next wave of publications will continue reshaping the field. "Every year that goes by, you can see 20, 30 articles coming out of this," he said. "It's going to change the way that we view healthcare." For decades, spine surgery has had to defend itself against a familiar critique: expensive operations, uncertain benefit, too many revisions and insufficient proof. e five-year data does not suggest every patient should have surgery. It suggests the specialty can finally answer with evidence. In the right patient, the benefits can last. Patients can return to work. ey can reduce opioids. ey can regain function. ey can remain satisfied even when improvement is incomplete. And health systems can evaluate spine care by what happens not only at discharge or one year later, but half a decade aer the operation. at may be the most important shi. Spine surgery finally has a long- term report card. And according to Dr. Mummaneni, it tells a more hopeful story than many people have been led to believe. n