The American Spine Registry: a foundational overview and data specifications for future research

Degenerative spine disease represents one of the most prevalent and costly health issues globally. As these costs continue to rise and the effectiveness of spine procedures remains variable, the need for standardized data collection and quality monitoring is paramount.

To provide the data specifications and descriptive of the American Spine Registry (ASR), a collaborative initiative between the American Association of Neurological Surgeons (AANS) and the American Academy of Orthopaedic Surgeons (AAOS), established to collect high-quality data on spine procedures.

Retrospective observational study analyzing prospectively collected ASR data from 2020 to 2023 across over 270 participating U.S. spine centers.

Patients undergoing cervical or lumbar spine surgery for degenerative conditions at over 270 participating U.S. spine centers between January 2020 and June 2023.

Reoperation rates, timing of reoperations, types of procedures performed (eg, ACDF, TLIF).

Launched in 2020, the ASR has integrated procedural data from over 270 participating sites across two core modules: degenerative cervical and degenerative lumbar spine. The registry captures comprehensive patient demographics, surgical details, and postoperative outcomes, including complications, readmissions, and reoperations within 30 and 90 days. Additionally, the ASR incorporates Patient-Reported Outcomes Measures (PROMs) such as PROMIS, VR-12, Oswestry Disability Index (ODI), Neck Disability Index (NDI) and Numeric Rating Scale (NRS) to assess functional recovery.

Between January 1, 2020, and June 27, 2023, the ASR Cervical Module (N=45,013) was dominated by anterior cervical discectomy and fusion (ACDF, 64.0%), followed by instrumentation (30.6%) and posterior fusion (22.4%). The Lumbar Module (N=184,682) most frequently included transforaminal/posterior lumbar interbody fusion (32.3%), posterior disc laminectomy (29.5%), and posterolateral fusion (29.2%). Overall reoperation rates were 5.8% in the cervical group versus 10.4% in the lumbar group, with "Other" causes (eg, infection, wound-related complication, pain) accounting for a larger share in lumbar (8.1%) than cervical (4.6%). Notably, adjacent segment disease (ASD) was also more common in lumbar patients (1.4% vs 0.1%). For timing of reoperation, a greater proportion of lumbar patients underwent reoperation within both the short-term (≤30 days: 3.6% vs 2.6%) and long-term (>90 days: 4.7% vs 1.8%) intervals.

The ASR represents a critical advancement in spine surgery data collection, providing valuable insights into practice patterns, outcomes, and opportunities for quality improvement. The registry has a total of 229,695 procedures recorded between 2020 and 2023. By leveraging standardized data, the ASR supports evidence-based decision-making and enhances the overall quality of spine care.