Pavlina Lenga

Purpose: Between lumbar decompression and the first follow-up visit (~ 6 weeks post-op), the day-to-day course of recovery is not routinely captured in detail. We tested whether a single-item, smartphone well-being ePROM (“How are you today?”, 0–100 VAS; higher = better), sent every 2–3 days, could be deployed in routine care, what level of endpoint completion was achieved, whether it showed preliminary convergent validity when measured at the same visit as clinic PROMs (ODI, PHQ-9), and whether serial responses could illustrate postoperative recovery trajectories. Methods: Consecutive patients with degenerative lumbar disease completed a digital baseline survey (Feb 1–Aug 31, 2025; n = 429). Patients with an operative indication for lumbar disc herniation or spinal canal stenosis who underwent lumbar decompression entered postoperative high-frequency well-being monitoring for 6 weeks. Patients were not included in the digital follow-up pathway when web-based participation was not feasible in routine care. The pathway generated electronic health record-accessible submissions but did not include automated alert thresholds or a mandated alert-to-action protocol. Results: Of 183 operated patients invited to postoperative monitoring, 70/183 (38.3%) contributed an evaluable clinic ODI at ~ 6 weeks, 68/183 (37.2%) had a same-day PHQ-9, and 48/183 (26.2%) were endpoint-complete for both visit-day measures; this low endpoint-completion rate represents a major implementation barrier. In the pair-level timing dataset, same-day well-being versus reverse-coded ODI (100 − ODI; higher = less disability) showed moderate concordance (ρ = 0.54, 95% CI 0.37–0.68; n = 107 pairs), with similar moderate estimates at short lags (≤ 2 days ρ ≈ 0.46; ≤4 days ρ ≈ 0.42), while longer-lag estimates were exploratory and non-monotonic. On the visit day, well-being related inversely to depressive burden (PHQ-9 ρ = −0.25; n = 68). In a joint model using raw ODI and PHQ-9, higher disability and higher depressive burden were associated with lower concurrent well-being (standardized β: −0.35 for ODI; −0.20 for PHQ-9), although explained variance was limited (adjusted R² = 0.151). Conclusion: Routine-care deployment was technically possible, and time-aligned measures showed preliminary convergent validity, but endpoint completion was low (26.2%) and prevents any claim of broad feasibility or universal scalability. The ePROM should be considered a hypothesis-generating trajectory signal that requires equity safeguards and prospective closed-loop alert-to-action testing before implementation as a clinical decision tool.

Study Design: Prospective observational cohort study. Objective: Standard postoperative follow-up often fails to capture rapid fluctuations in symptoms after degenerative lumbar spine surgery. This study evaluated the construct validity of a high-frequency, low-burden “Global Postoperative Status” item as an exploratory measure of concurrent early post-discharge recovery burden. Methods: Prospective observational cohort study of 257 patients undergoing surgery for lumbar disc herniation or spinal canal stenosis who contributed 1627 postoperative status assessments over 6 weeks via secure mobile surveys every 2-3 days. Construct validity was examined through associations with pain-peak frequency, pain-peak intensity (0-10), analgesic use, and wound pain. Because peak intensity was conditionally collected only when pain peaks were reported, the primary mixed-effects complete-case model included 209/1627 assessments (82 subjects); broader sensitivity analyses used larger available-case datasets. Results: Worse Global Status scores were consistently associated with greater concurrent pain burden. Median status was 60 (IQR 50-80) when no pain peaks were reported vs 40 (IQR 20-50) when pain peaks occurred >5/day. Mean status was 67.2 without analgesics and 41.9 with combined opioid plus non-opioid analgesics. Status correlated inversely with pain peak intensity (Spearman rho = −0.53, P < 0.001). In the exploratory complete-case mixed-effects model, each 1-point increase in pain peak intensity was associated with a 4.53-point lower status score (95% CI -6.09 to −2.97; P < 0.001); this direction was preserved in broader sensitivity analyses that retained more observations. Conclusions: The high-frequency Global Status item showed exploratory construct-validity evidence as a low-burden indicator of concurrent postoperative pain burden and analgesic use after lumbar spine surgery. The findings do not establish responsiveness, test-retest reliability, criterion validity against established PROMs, or decision-support utility, and prospective validation studies are required before clinical implementation claims can be made.

Two-stage circumferential fusion incorporating lateral lumbar interbody fusion (LLIF) is increasingly used to treat degenerative lumbar disorders, yet evidence on perioperative safety, clinical benefit, and optimal sequencing remains limited. We evaluated clinical outcomes, radiographic realignment, perioperative morbidity, and predictors of complications in patients undergoing staged LLIF with posterior fixation. We retrospectively reviewed 20 patients (mean age 67.7 years) who underwent two-stage lumbar fusion, either LLIF followed by posterior instrumentation or vice versa. We assessed pain (NRS scale), segmental lordosis (SL), blood loss, ICU and hospital length of stay, and complications. Subgroup analysis compared LLIF-first vs. posterior-first sequencing. Logistic regression identified predictors of complications. Patients showed a median age-adjusted Charlson Comorbidity Index [ACCI] of 3.0. LLIF was performed first in 65%. Mean NRS pain scores improved from 6.5 preoperatively to 4.1 after the first stage ( p = 0.006) and to 3.1 after the second ( p < 0.001). Early pain relief tended to be greater with LLIF-first (ΔNRS − 2.46 vs. − 1.75). Posterior-first sequencing involved more instrumented levels (median 4 vs. 2, p = 0.014), greater blood loss (628.6 vs. 142.3 mL, p = 0.01), and longer hospitalization (18.9 vs. 10.8 days, p < 0.001). LLIF-first yielded greater intervertebral height gain (6.5 vs. 3.7 mm, p = 0.05). SL improved mainly at upper lumbar levels (+ 6.4°). ACCI was the only independent predictor of complications (OR 2.6 per point; p = 0.045). Staged lateral lumbar interbody fusion with posterior instrumentation appears to be a feasible treatment option for complex degenerative lumbar disease, associated with early pain relief and segmental alignment changes. Performing the interbody fusion as the first stage may offer potential advantages; however, these findings should be interpreted cautiously given the small sample size of our cohort.

This study assessed the technical and clinical feasibility of capturing detailed, high-frequency Patient-Reported Outcome Measure (PROM) trajectories by integrating short instruments directly into the Electronic Health Record (EHR) system. Current practice uses infrequent PROMs, failing to capture the dynamic nature of a patient’s trajectory. We designed and implemented an electronic data capture system that securely sent single-item Quality of Life (QoL) and pain assessments to patients’ smartphones for direct EHR integration. The system was tested in cohorts from neurosurgery (182 patients, every 2-3 days for 30 days) and psychosomatics (71 patients, weekly for 60 days). Results showed high temporal variability in QoL (mean coefficient of variation 30.5% in neurosurgery), underscoring the need for frequent assessment. The single-item QoL demonstrated clinical validity, correlating highly significantly with pain (p<10E-10). We successfully maintained high response rates, finding that the combination of EHR integration (providing clinical relevance) and short instruments (minimizing burden) is crucial for success. These high-resolution patient trajectories are feasible in real-world settings, offering a powerful tool for both personalized clinical management (e.g., early complication detection) and serving as a comprehensive outcome for future clinical research which can be more informative than survival.

Background: Hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) is common, but bedside markers of its physiological burden are limited. Quantitative pupillometry (QP) is objective and fast; whether it mirrors hydrocephalus severity is uncertain. Methods: Single-center cohort of adults with aSAH undergoing ventriculoperitoneal shunting ( n = 17). Automated infrared pupillometry (NPi-200) was performed the day before surgery and on post-op day 1, recording Neurological Pupil index (NPi) and constriction/dilation velocities (CV/DV) as overall values (mean of both eyes) and inter-eye asymmetry (|OD–OS|). Pre-op CT markers were combined into a standardized Hydrocephalus Severity Score (HSS; higher=worse). Results: Mean pre-op NPi was 3.81 ± 0.69 and post-op 4.03 ± 0.66; median ΔNPi = + 0.13 (Wilcoxon p = 0.141). Responders (ΔNPi ≥ + 0.5) were 5/14 (35.7%). Cross-sectionally, overall values did not mirror ventricular size: NPi vs. HSS (ρ = 0.37, p = 0.141, q = 0.423) and NPi vs. Evans index (EI) (ρ = 0.09, p = 0.735, q = 0.735) were non-significant; CV/DV vs. HSS were likewise neutral. In contrast, inter-eye CV asymmetry correlated with HSS (ρ = 0.68, p = 0.006, q = 0.017; n = 16) and trended with Evans (ρ = 0.49, p = 0.054, q = 0.161). In age/sex-adjusted models, no radiologic metric, including HSS, reliably explained pathological NPi (< 3). Conclusions: In shunt-dependent aSAH hydrocephalus, pattern matters more than absolute value. Absolute NPi and mean velocities did not reflect ventricular size, whereas inter-eye constriction-velocity asymmetry captured composite radiologic burden, consistent with lateralized parasympathetic stress. Around shunt placement, QP behaved as a dynamic biomarker, revealing patient-level gains despite flat cohort averages. Findings support trend- and asymmetry-based pupillometry to complement imaging for CSF-pathway reassessment and early post-shunt surveillance, warranting prospective validation.

Background: Patient-reported outcome measures (PROMs) such as health-related quality of life (HRQoL) are usually assessed at greater time intervals such as diagnostic time points, after treatment, and during follow-up. Many PROMs require frequent data collection (weekly or daily). Electronic PROMs enable high-resolution tracking but face declining response rates. Integrating PROMs into electronic health records (EHRs) could improve response rates and personalize therapy. Objective: This study aimed to evaluate the technical and clinical feasibility of high-frequency HRQoL assessments for routine care in EHRs. Methods: Patients receive emails on their mobile devices with 1-time links to a web-based app called MyEDC. This app communicates with an electronic data capture proxy in the demilitarized zone of the hospital. With a polling mechanism, these patient data are transferred to the protected hospital network and uploaded to the EHR system. HRQoL on a visual analog scale is assessed over the course of treatment in 4 clinical use cases: psychosomatics, hematology, visceral surgery, and neurosurgery. Results: Quality of life (QoL) trajectories were collected for 110 patients with daily or weekly data collection between 2 weeks and 3 months. The HRQoL analyses revealed clinically relevant findings across the 4 different medical domains. In the use case psychosomatics, 36 patients showed a significant increase in HRQoL following 4 weeks of therapy, rising from a median of 42% (IQR 32%-52%) to 60% (IQR 41%-67%; P=.01). An analysis of 25 patients in hematology demonstrated a significant correlation between HRQoL and 30-item QoL Questionnaire (EORTC QLQ-C30) global health status score (P=.02). For 26 patients in visceral surgery, a significant association was observed between HRQoL and the reported pain level (P<.001). The clinical feasibility was further highlighted in the neurosurgery use case, where 23 patients showed a median response time to the electronic PROM questionnaires of 5.3 (IQR 0.6-17.7) hours. HRQoL values were associated with disease-specific symptoms and scores, indicating clinical validity of this readout. Considerable variability of HRQoL was observed over time, both intraindividually and interindividually. Median area under the curve of HRQoL ranged from 0.46 to 0.79. Median time to answer ranged from 0.9 to 7.1 hours. No significant association between number of responses and age was observed. Conclusions: High-resolution QoL trajectories with EHR integration are technically and clinically feasible. They offer a novel readout beyond survival analysis or PROM end point, enabling precise disease characterization and treatment comparison.