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Development of the Forgotten Spine Surgery Score for Cervical Spine Surgery (FS3-C): An Adapted Method to Assess
Chad Z Simon1, Cole T Kwas, Arsen M Omurzakov
1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Study Design:
Prospective questionnaire development and validation study.
Objective:
To develop and validate a new "Forgotten Spine Surgery Score for Cervical Spine Surgery" (FS3-C) to assess patient outcomes after CDR beyond the traditional measures: the ability to forget the presence of the implanted disc in daily life.
Summary Of Background Data:
The Forgotten Joint Score (FJS) has demonstrated superior discrimination in high-functioning total joint arthroplasty patients due to low ceiling and floor effects compared to legacy patient-reported outcome measures (PROMs). To date, there is no similar outcome measure to assess "forgottenness" following spine surgery. Such measures may be critical for evaluating subtle differences in high-performance surgeries like cervical disc replacement (CDR).
Methods:
A 20-item pilot questionnaire was developed based on published patient expectations and expert opinion, utilizing a 5-point Likert scale. This was administered to 41 patients who underwent primary one- or two-level CDR (minimum 3-month follow-up, 2016-2023) for item selection and internal validity assessment. The final 12-item FS3-C was validated in 97 patients and correlated with the neck disability index (NDI) to determine convergent validity.
Results:
In the pilot cohort (mean age 44.7±7.9 y), four items were excluded due to high missing responses or ceiling effects. In the pilot cohort (mean age 44.7±7.9 y), four items were excluded due to high missing responses or ceiling effects. The remaining 16 items demonstrated high internal consistency (Cronbach's alpha 0.95-0.96). Pairwise correlation analysis reduced the questionnaire to 12 items. In the validation cohort (mean age 44.3±9.0 y, 56.7±24.2 mo post-surgery), FS3-C demonstrated high internal consistency with minimal ceiling effects. Mean FS3-C and NDI scores were 86.4±18.9 and 9.8±12.6, respectively, with strong correlation (r=-0.606, P<0.001).
Conclusion:
The FS3-C demonstrates high internal consistency, low ceiling effects, and strong convergent validity with NDI, enabling spine surgeons to evaluate CDR success beyond traditional symptom improvement measures.
Level Of Evidence:
II.
