Spine Surgery Database Research Articles

Incidence and risk factors for incidental durotomy in spine surgery for lumbar stenosis and herniated disc.

Incidental durotomy (ID) is one of the most common complications in degenerative surgery. Due to the negative consequences of ID, knowledge about incidence and risk factors is warranted. A total of 1,139 surgical procedures for lumbar spinal stenosis (LS) and lumbar herniated disc (LDH) were included from the spine surgery database: DaneSpine. Uni- and multivariate analyses were performed for the assessment of possible risk factors. ID occurred in 10.4% of the surgical procedures. A multivariate regression analysis revealed an increased relative risk of ID by 2% per year of age, 58% by revision surgery, and 55% by decompression on multiple levels. In our single-centre cohort study, one in ten patients experiences an ID. Increasing age, revision surgery and decompression of multiple levels are risk factors of ID in degenerative surgery of the lumbar spine.

Risk Factors for Postoperative Ileus in Patients Undergoing Spine Surgery.

Retrospective Cohort Study. Postoperative ileus (POI) is a common complication following elective spinal surgeries. The aim of this study was to determine the incidence of POI and identify demographic and surgical risk factors for developing POI after elective instrumented fusion of the thoracolumbar spine. The University of Utah Institutional Review Board (IRB) approved this retrospective study. The study does not require informed consent given the data reviewed was deidentified and collected in accordance with the institution's standard of care. A designated IRB committee determined that study is exempt under exemption category 7. IRB approval number 00069703. Patients undergoing instrumented thoracolumbar fusion for one or more levels were retrospectively identified from an internal spine surgery database. Cases performed for trauma, infection, or tumors were excluded. Demographics, medical comorbidities, surgical variables, and opioid medication administration (morphine milligram equivalents, MME) were abstracted from the electronic medical record. Univariate analysis was used to identify variables associated with POI. These variables were then tested for independent association with POI using multivariate logistic regression. 418 patients were included in the current study. The incidence of POI was 9.3% in this cohort. There was no significant relationship between development of POI and patient age, gender, BMI, diabetes mellitus, thyroid dysfunction, lung disease, CKD, GERD, smoking status, alcohol abuse, anemia, or prior abdominal surgery. Univariate analysis demonstrated significant association between POI and fusion ≥7 levels compared to fusions of fewer levels (P = .001), as well as intraoperative sufentanil compared to other opioids (35.9% vs 20.1%, P = .02). POI was not significantly associated with total intraoperative MME, approach, use of interbody cage, or osteotomy. Multivariate logistic regression confirmed total 24-hour postoperative MME as an independent risk factor for POI (OR 1.004, P = .04), however, intraoperative sufentanil administration was not an independent risk factor for POI when controlling for other variables. This retrospective cohort study demonstrates that greater postoperative MME is an independent risk factor for POI after thoracolumbar spine fusion when accounting for demographic, medical, and surgical variables with multiple logistic regression. Prospective studies are warranted to evaluate clinical measures to decrease the risk of POI among patients undergoing instrumented thoracolumbar spinal fusions.

APRESENTAÇÃO DO BANCO DE DADOS DE COLETA MULTICÊNTRICA DE CIRURGIA DA COLUNA

ABSTRACT Objectives: To present the Spine Surgery Database developed by the Brazilian Spine Study Group and the methodology involved in its creation, in addition to presenting initial informationabout the use of the database. Methods: Description of the steps for selecting the questionnaires and variables to be included in the database, initial expansion of the use of the database tophysicians close to the BSSG, a brief exploration of quality control and methods for the inclusion ofnew centers, and training on the database, in addition to a brief descriptionof some of the data included in the database. Results: Currently, the database includes 428 patients who already underwent spine surgery and 9 collection centers with at least one patient collected. Conclusion: The Brazilian Spine Study Group’s Multicentric Collection Database is a viable tool that allows patients from different sourcesto be included within a common flow. Level of Evidence V; Expert opinion.

A cost benefit analysis of increasing surgical technology in lumbar spine fusion

Numerous advances have been made in the field of spine fusion, such as minimally invasive (MIS) or robotic-assisted spine surgery. However, it is unknown how these advances have impacted the cost of care. Compare the economic outcomes of lumbar spine fusion between open, MIS, and robot-assisted surgery patients. Retrospective review of a single center spine surgery database. Three hundred sixty propensity matched patients. Costs, EuroQol-5D (EQ5D), cost per quality adjusted life years (QALY). Inclusion criteria: surgical patients >18 years undergoing lumbar fusion surgery. Patients were categorized into 3 groups based on procedure type: open, MIS, or robotic. Open patients undergoing poster spinal fusion were considered as the control group. MIS patients included those undergoing transforaminal or lateral lumbar interbody fusion with percutaneous screws. Robotic patients were those undergoing robot-assisted fusion. Propensity score matching was performed between all groups for the number of levels fused. Costs were calculated using the PearlDiver database, which reflects both private insurance and Medicare reimbursement claims for ICD-9 codes. For robotic cases, costs were reflective of operational fees and initial purchase cost. Complications and comorbidities and major complications and comorbidities were assessed according to CMS.gov manual definitions. QALYs and cost per QALY were calculated using a 3% discount rate to account for residual decline to life expectancy (78.7 years). Costs per QALY were calculated for both 1 year and life expectancy, assuming no loss of benefit. A 10,000 trial Monte Carlo simulation with probabilistic sensitivity analysis (PSA) assessed our model parameters and costs. Three hundred sixty propensity matched patients (120 open, 120 MIS, 120 robotic) met inclusion criteria. Descriptive statistics for the cohort were: age 58.8±13.5, 50% women, BMI 29.4±6.3, operative time 294.4±119.0, LOS 4.56±3.31 days, estimated blood loss 515.9±670.0 cc, and 2.3±2.2 average levels fused. Rates of post-op complications were significantly higher in robotic cases versus open and MIS (43% vs. 21% and 22% for open and MIS, p<.05). However, revision rates were comparable between all groups (3% open, 3% MIS, 5% robotic, p>.05). After factoring in complications, revisions, and purchasing and operating fees, the costs of robotic cases was significantly higher than both open and MIS surgery ($60,047.01 vs. $42,538.98 open and $41,471.21 MIS). In a subanalysis of 42 patients with baseline (BL) and 1Y EQ5D data, the cost per QALY at 1Y for open, MIS, and robot-assisted cases was $296,624.48, $115,911.69, and $592,734.30. If utility gained was sustained to life expectancy, the cost per QALY was $14,905.75, $5,824.71, $29,785.64 for open, MIS, and robot-assisted cases. Results of the PSA were consistent with MIS surgery having the most incremental cost effectiveness when compared to open and robotic surgery. Numerous advances have been made in the field of spine surgery, however, there has been limited discussion of the effect these advances have on economic outcomes. When matched for levels fused, robot-assisted surgery patients had significantly higher rates of complications and 30% higher costs of surgery compared to minimally invasive and open spine surgery patients. While 1 year economic outcomes were not optimal for robotic surgery cases, the projected costs per QALYs at life expectancy were well below established acceptable thresholds. The above findings may be reflective of an educational learning curve and emerging surgical technologies undergoing progressive refinement.

280. The risk factors of respiratory complications after posterior spine deformity surgery for patients with early onset scoliosis

BACKGROUND CONTEXT Early onset scoliosis (EOS) is associated with high morbidity and some of them require posterior spine deformity surgery (PSDS). Respiratory complications following PSDS are common, and have been reported in 15.6% to 28.2% of operative cases. Postoperative complications following PSDS may cause further impairment of respiratory function, leading to prolonged intubation time, need for reintubation, and longer inpatient hospital stay. PURPOSE We assumed that there were preoperative laboratory values and patient factors that are associated with postoperative respiratory complications (RCs) in EOS populations undergoing PSDS. To determine the risk factors of RC in EOS undergoing PSDS. STUDY DESIGN/SETTING A retrospective analysis with prospective outcomes research. PATIENT SAMPLE All patients who underwent PSDS for EOS in a single institute from 2008-2018. OUTCOME MEASURES Preoperative laboratory values for transferrin, prealbumin, hemoglobin/hematocrit, total protein, albumin, total lymphocyte count and blood loss to total blood volume ratio (BL/TBV) were collected. METHODS The spine surgery database was reviewed to identify all patients who underwent PSDS for EOS in a single institute from 2008-2018. RC was defined as postoperative pneumonia, pleural effusion, pneumothorax, need for reintubation, respiratory status requiring a return to the intensive care unit, or prolonged (>4-day) need for mechanical ventilation. Preoperative laboratory values for transferrin, prealbumin, hemoglobin/hematocrit, total protein, albumin, total lymphocyte count and blood loss to total blood volume ratio (BL/TBV) were collected. RESULTS There were 76 patients included in our study. Results of single-factor comparison demonstrated that the following seven variables were statistically different (P 15% (X9). The multi-factor unconditional logistic regression analysis revealed that X8 (OR=49.322), X9 (OR=18.423), X5 (OR= 11.883), and X6 (OR=8.769) were independent and positively correlated with the RC. CONCLUSIONS Albumin 15%, history of pneumonia and transferrin FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Spine Surgery Database: Spine Disease Analytical Evaluation Module.

To demonstrate a custom spine disease analytical evaluation module that can instantly, accurately, and effectively analyze the widely accepted outcome measurements. The data input and analysis processes were evaluated on a timely basis to compare the traditional paper-based manual data entry method with the spine surgery database (SSD) platform data entry method. The data of 116 patients in the cervical degenerative patient group were analyzed using the upgraded version of the SSD. The subjects were analyzed with respect to the SF-36 Quality of Life Index, Nurick classification, and Japanese Orthopedic Association score. The manual and computerized patient information analyses were then compared. The developed analysis module enables the instantaneous access and analysis of patient data. More importantly, the paperless evaluation module improves the post-surgery patient status evaluation time by 45.64%. For 116 patients, a physician gains up to 401 min of evaluation time in each preoperative and follow-up period without being subjected to the human errors encountered in paper records. It is apparent that customized software solutions are absolutely necessary in patient registration and follow-up processes. The experimental results showed that using the proposed module, patient follow-up and progress analyses can be performed in a fast, effective, and accurate manner.

The clinical and radiological outcomes of multilevel posterior lumbar interbody fusion in the treatment of degenerative scoliosis: a consecutive case series with minimum 2 years follow up.

Surgical treatment for adult degenerative scoliosis (ADS) is a complex undertaking and is associated with a high complication rate. Our aim was to evaluate the clinical and radiological outcomes, mortality and morbidity of multilevel posterior lumbar interbody fusion (MPLIF) in the treatment in ADS based on the experience of a single tertiary referral center for spinal surgery. We performed a retrospective analysis of prospectively collected data of consecutive patients who had undergone multi-level posterior interbody fusion for degenerative scoliosis. We prospectively recorded patients' demographics, co-morbidities; coronal and sagittal plane deformity assessment and surgical details: number of instrumented levels, and intra-operative and postoperative complications. Functional outcomes and patient-reported complications were entered in our local spine surgery database (part of the Eurospine Spine Tango Registry) and used to collect data on functional scores and patient-reported complications preoperatively and at 6, 12 and 24 months' follow-up. Our study involved 13 males and 51 females with a mean age of 70.26 (range 49-90, SD 8.9). MPLIF was performed at five levels in one patient, four levels in 29 patients, three levels in 20 patients, and two levels in 14 patients. There were a total of 14 (21.87%) major, minor and mechanical complications. There were no procedure-related mortalities. The average COMI and Eq5d scores improved significantly post-surgery, and this improvement was maintained at a mean follow-up of up to two years. Multilevel posterior interbody fusion is a safe procedure, and in selected cases can result in good clinical and radiological outcomes with improvement in patient quality of life.

Preoperative Variables Associated With Respiratory Complications After Pediatric Neuromuscular Spine Deformity Surgery

ObjectiveThe objective of this study is to identify preoperative laboratory values and patient factors that are associated with postoperative respiratory complications in pediatric neuromuscular scoliosis (NMS) populations undergoing posterior spinal fusion (PSF) with instrumentation. Summary of Background DataPSF in NMS patients are high-risk surgeries. Respiratory complications are the most common postoperative event, with rates up to 28.2% following surgery. MethodsA single-surgeon, two-hospital pediatric spine surgery database was reviewed to identify all patients who underwent PSF for NMS. Diagnoses included cerebral palsy (n=83), myelomeningocele (n=13), spinal muscular atrophy (n=4), and other (n=11). This study defined respiratory complications as postoperative pneumonia, pleural effusion, pneumothorax, need for reintubation, respiratory status requiring a return to the pediatric intensive care unit (PICU), or prolonged (>4-day) need for mechanical ventilation. Preoperative laboratory values for transferrin, prealbumin, hemoglobin/hematocrit, total protein, albumin, and total lymphocyte count were collected. ResultsThere were 50 males and 61 females with a mean age of 14 years 2.5 months (8–20 years). Seventeen patients (15.3%) experienced postoperative respiratory complications. On univariate analysis, any history of pneumonia, the presence of gastrostomy tube, and low transferrin levels were associated with postoperative respiratory complications, and a strong trend (p=.06) was observed for tracheostomy. On multivariate analysis, the presence of gastrostomy tube and history of pneumonia remained as clinically significant predictors of postoperative respiratory complications. ConclusionPediatric NMS patients undergoing PSF that have history of pneumonia or gastrostomy tube present at time of surgery are at increased risk for postoperative respiratory complications. The univariate associations of tracheostomy presence and low transferrin levels with postoperative respiratory complications deserve further examination. Level of EvidenceLevel II.

Preoperative MRSA Screening in Pediatric Spine Surgery: A Helpful Tool or a Waste of Time and Money?

ObjectivesTo review the use of preoperative screening for Staphylococcus aureus for all pediatric spine procedures that was instituted at our facility in a multimodal approach to decrease the frequency of postoperative wound infections. Summary of Background DataFour years ago at our facility, a multimodal approach to decrease the frequency of postoperative infections after pediatric spine surgery was instituted. MethodsA single-center, single-surgeon pediatric spine surgery database was queried to identify all patients who had preoperative S. aureus nasal swab screening. Data collected included demographic data, diagnoses, methicillin-resistant S. aureus (MRSA) swab findings, bacterial antibiotic sensitivities, and outcome of the spine surgery. ResultsA total of 339 MRSA screenings were performed. Twenty (5.9%) were MRSA positive, and 55 (16.2%) were methicillin-sensitive S. aureus (MSSA) positive. In the MRSA-positive group, 13 were neuromuscular, 5 were adolescent idiopathic scoliosis (AIS), 1 congenital, and 1 infantile idiopathic scoliosis. Of the MRSA-positive screenings, 13 (65.0% of MRSA-positive screenings; 3.8% of entire cohort) of were newly identified cases (9 neuromuscular, 3 AIS, and 1 congenital diagnoses). In the 55 MSSA-positive, 6 documented resistance to either cefazolin or clindamycin. Hence, in up to 22 of the preoperative screenings (6.5% of entire cohort; 16 MRSA and 6 MSSA showed antibiotic resistance), the preoperative antibiotic regimen could be altered to appropriately cover the identified bacterial resistances. During the study period, there were 11 patients who were diagnosed with a postoperative deep wound infection, none of them having positive screenings. ConclusionThe use of preoperative nasal swab MRSA screening permitted adjustment of the preoperative antibiotic regimen in up to 6.5% of patients undergoing pediatric spine surgery. This inexpensive, noninvasive tool can be used in preoperative surgical planning for all patients undergoing spinal procedures. Level of EvidenceLevel IV.

The Use of Somatosensory Evoked Potentials to Determine the Relationship Between Intraoperative Arterial Blood Pressure and Intraoperative Upper Extremity Position-Related Neurapraxia in the Prone Surrender Position During Spine Surgery: A Retrospective Analysis.

Peripheral nerve injury is a significant perioperative problem. Intraoperative position-related neurapraxia may indicate impending peripheral nerve injury and can be detected by changes in somatosensory evoked potentials (SSEP). The purpose of this retrospective analysis of spine surgeries performed under general anesthesia with SSEP monitoring was to determine the relationship between intraoperative mean arterial blood pressure (MAP) and intraoperative upper extremity position-related neurapraxia in the prone surrender (superman) position. We reviewed a computerized database of spine surgeries performed on adult patients in the prone surrender position. The authors reviewed intraoperative SSEP monitoring reports to identify the patients who developed intraoperative upper extremity position-related neurapraxia (case group) and patients who did not (control group). Propensity matching was performed to derive 2 demographically matched groups. Preoperative and intraoperative variables were included in the univariate Cox regression analysis of risk factors associated with neurapraxia. Multivariate Cox regression models were used to identify the independent risk factors. One hundred fifty-two patients were included in the analysis. The case group included 32 patients, whereas the control group included 120 matched patients. Intraoperative MAP <55 mm Hg for a total duration of ≥5 minutes was an independent risk factor associated with a greater incidence of upper extremity position-related neurapraxia compared with a duration of <5 minutes with MAP <55 mm Hg (hazard ratio, 3.43; confidence interval, 1.445-8.148; P = 0.0052). Intraoperative MAP >80 mm Hg for a total duration of >55 minutes was an independent predictor associated with a lower incidence of neurapraxia compared with a total duration ≤55 minutes (hazard ratio, 0.341; confidence interval, 0.163-0.717; P = 0.0045). In this study, we identified the changes in intraoperative MAP as independent predictors associated with upper extremity position-related neurapraxia in the prone surrender position under general anesthesia.

Outcomes and Complications of Minimally Invasive Surgery of the Lumbar Spine in the Elderly.

Introduction: Minimally invasive spine (MIS) surgery is gaining popularity in the elderly. With aging population and a strong desire for all patients to remain physically active, this trend will likely continue. Previous studies have reported clinical outcomes in the elderly undergoing MIS surgery; however, most of these studies encompass multiple surgeons at different sites and thus present heterogeneous experiences. In this work, we investigate the clinical outcomes and complications of all lumbar MIS procedures performed in patients over 65 years of age by a single surgeon.Methods: A retrospective analysis of a prospectively maintained database of spine surgeries was performed. Twenty-six patients who underwent 27 procedures were included.Results: Mean age at surgery was 72 years (range 64-86). The mean BMI was 30.2 kg/m2, patients had an average of 5 comorbidities, took 9 medications, and 15% were smokers. The mean symptoms duration was 40.6 months with the numeric rating scale (NRS) and the Oswestry disability index (ODI) prior to surgery of 7.68 and 50% respectively. Six different types of procedures were performed, the most common was the interlaminar decompression and fusion (ILIF) followed by MIS laminectomy, microdiscectomy and MIS lateral fusion (XLIF). 74% of the surgeries were done at a single level. Average blood loss was 43 mL, and the mean length of stay was 1.7 days. There were three complications (11.1%): one urinary tract infection, one pulmonary embolism, and one new, postoperative weakness. At six months follow-up, there was a mean improvement of 27% in ODI, and a 5.6 improvement in NRS (both p<0.05); 90% of patients stated they would have the surgery again.Conclusion: Minimally invasive lumbar spine surgery is both safe and highly effective in the elderly population. Patient selection is of utmost importance. This data will add to the existing literature on the overall safety and effectiveness of these procedures in the elderly population.

Adult degenerative scoliosis: comparison of patient-rated outcome after three different surgical treatments.

Few studies have examined the effectiveness of surgical treatment for adult degenerative scoliosis (ADS) using validated patient-orientated outcome instruments. This study reports patient outcomes in a large, consecutive series of patients being treated for ADS by simple decompression (D), short fusion (SF), or long fusion (LF). Our local spine surgery database (part of the Eurospine Spine Tango Registry) was used to acquire the data from patients with ADS undergoing D, SF or LF. Preoperatively and at 12 and 24months follow-up (FU), patients completed the multidimensional Core Outcome Measures Index (COMI; 0-10); at FU, satisfaction and global outcome were rated on a five-point Likert scale and dichotomised as "good" and "poor", and patient-rated complications were recorded. 173 patients took part (81 D, 53 SF, 39 LF). Compared with the two fusion groups, the D group was significantly older, had more comorbidity, and had more leg pain than back pain (each p<0.05). There were significant differences among the groups for operation duration, blood loss and general complications (each p<0.05), in each case with the LF group showing the greatest values and the D group the lowest values. However, patient-rated complications were not significantly different between the groups (p>0.89). Further surgery within the 2-year follow-up was required in 7% of the D group, 15% in SF and 28% in LF. All groups benefited significantly from surgery with no significant differences (p>0.05) between them: improvement in COMI after 24months was 2.9±2.8 points for D, 3.1±3.3 points for SF and 3.2±3.1 points for LF; a "good global outcome" was recorded for 69, 74 and 76% patients, respectively. Despite the complexity of the disease, patient-orientated outcomes after surgery for ADS were similar to those previously reported using the same outcome instruments in patients with lumbar stenosis and degenerative spondylolisthesis. The use of D, SF and LF for ADS yielded similarly good results from the patient's perspective. This most likely reflects careful and appropriate patient selection. Further analyses are warranted to identify baseline variables predicting the 26-31% cases in each group with a poor outcome.

Clinical Decision Making in Early Wound Drainage Following Posterior Spine Surgery in Pediatric Patients

Study DesignRetrospective. ObjectivesTo identify the clinical factors suggestive of infected and non-infected drainage to help clinical decision making. Summary of Background DataDifferentiating between drainage caused by a benign seroma and deep spinal infection may be difficult in the early postoperative period. MethodsInstitutional spine surgery database was searched to identify the cases that were taken back to the operating room for drainage from the surgical wound in the early postoperative period between 2000 and 2012. ResultsA total of 38 cases of early wound drainage (within 6 weeks postoperatively) were identified that were treated with opening all layers, irrigation, and debridement. Intraoperative cultures were sent in all cases. Twenty-five patients proved to have non-infected drainage and did not require further treatment. In 13 patients, infection was confirmed with intra-operative findings and cultures; these patients were treated with serial debridements. In 4 cases, implants had to be removed after multiple debridements (after a quiescent period). The group with non-infected drainage differed from the infection group in that most patients (21 of 25) had non-neuromuscular deformities, whereas 77% of the infected group had neuromuscular etiology (10 of 13) (p = .0004). Average number of days to revision was 8.5 (range, 5–14 days) for the non-infected group. Of the 25 patients, 23 presented in the first 10 days. In the infected group, average number of days to revision was 19. Ten of the 13 patients presented on postoperative day 14 or later. Logistic regression analysis showed a significant association between increased likelihood of infection and increased time from the index procedure (p = .0085). ConclusionsThe findings suggest that early presenting drainage in pediatric idiopathic spine deformity is often not infected. Drainage, especially presenting after the second postoperative week in neuromuscular patients, proved to be mostly deep spinal wound infections.

Lumbar facet joint effusion in MRI: a sign of instability in degenerative spondylolisthesis?

The term "segmental instability" of the lumbar spine is not clearly defined, especially as it relates to degenerative spondylolisthesis (DS) and rotational translation (RT). We investigated whether facet joint effusion on conventional supine MRI indicated increased abnormal motion in DS and RT. 160 patients (119 female, 41 male, mean age 68.8 years, range 38.8-89.3 years) who had undergone decompression only or decompression with instrumented fusion for degenerative spondylolisthesis with different degrees of narrowing of the spinal canal were identified retrospectively from our spine surgery database. All had preoperative upright X-rays in AP and lateral views as well as supine MRI. The imaging studies were assessed for the following parameters: percent of slippage, absolute value of facet joint effusion, facet angles, degree of facet degeneration and spinal canal central narrowing, disc height, presence of facet cysts and the presence of rotational translation in the AP X-ray. 40/160 patients showed no facet joint effusion, and in these the difference in the values for the % slip on upright X-ray and % slip on supine MRI was ≤3%. A further 12 patients also showed a difference ≤3%, but had some fluid in the joints (0.44 ± 0.38 mm). In 108 patients, the difference in the % slip measured on X-ray and on MRI was >3% (mean 10.6%, range 4-29%) and was associated with a mean facet effusion size of 2.15 ± 0.85 mm. The extent of effusion correlated significantly with the relative slippage difference between standing and supine positions (r = 0.64, p < 0.001), and the extent of the left/right difference in effusion was associated with the presence of rotational translation (RT 1.31 ± 0.8 mm vs. no-RT 0.23 ± 0.17 mm, p < 0.0001). Facet joint effusion is clearly correlated with spontaneous reduction of the extent of slippage in the supine position compared to the upright position. Also, the greater the difference in right and left facet effusion, the higher the likelihood of having a RT. Future studies should assess whether analysis of facet joint effusion measured on routine MRI can help in decision-making regarding the optimal surgical treatment to be applied (decompression alone or combined with fusion).

Spine surgery database: a turkish registry for spinal disorders

This study presents a Turkish academic database application platform which is specialized for spinal surgery clinics. The application provides a userfriendly interface and easy access to the patients' data due to a hierarchical structure. Patient diagnosis, treatment and follow-up process data are recorded regularly and systematically. Another ambitious goal is to register the treatment outcomes to also provide an environment for analyzing patients' data. The Spine Surgery Database (SSD) application was designed as incorporating all content that can be used in the field of spine surgery expertise. The system has different tools for different purposes; main application, database creation, analysis and data merge tool. Widely accepted standards, Oswestry Disability Index, Prolo Scale, SF-36, etc., are used to assess outcome analysis. Diagnosis, treatment and follow-up processes were monitored in a standard structure. Distributions of general patient profile over pathological and anatomical information are represented using the SSD analysis tool. Over 22.000 patients' medical data were successfully recorded and the patient registration problem was resolved by using software applications. This specialized application presents a user-friendly interface which supplies all needs of spinal surgery. Questionnaires and scales which are very important for clinicians and researchers can be generated through the SSD tool.