Observational Study

. 2025 May 31;15(1):19143.

doi: 10.1038/s41598-025-03613-4.

The impact of elective spine surgery in Canada for degenerative conditions on patient reported health-related quality of life outcomes

Ragavan Manoharan^#^{1

2}, Nisaharan Srikandarajah^#^{1

3

4}, Jean-Christophe Murray⁵, Christopher Nielsen⁶, Supriya Singh⁷, Sean Christie⁸, Michael M H Yang⁹, Michael Weber¹⁰, Bernard Larue¹¹, Adrienne Kelly¹², Jerome Paquet¹³, Raphaele Charest-Morin¹⁴, Guy Hogan¹⁵, Andrew Glennie¹⁶, Henry Anh¹⁷, Eugene Wai¹⁸, Nicolas Dea¹⁴, Neil Mason^{19

20}, Kenneth Thomas⁹, Charles Fisher¹⁴, Hamilton Hall²¹, Christopher Bailey⁷, Mayilee Canizares²², Yoga Raja Rampersaud²³

Affiliations

¹ University of Toronto Spine Program, Toronto Western Hospital, Toronto, ON, Canada.
² Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia.
³ Department of Neurosurgery, The Walton Centre, Liverpool, United Kingdom.
⁴ Faculty of Health and Life Sciences, University of Liverpool, Liverpool, England.
⁵ Division of Orthopaedic Surgery, Department of Surgery, CHU de Québec - Université Laval Quebec City, Quebec, QC, Canada.
⁶ Schroeder Arthritis Institute, Krembil Research Institute, Department of Surgery, Division of Orthopaedic Surgery, University Health Network, University of Toronto, Orthopaedics, Toronto, ON, Canada.
⁷ London Health Science Centre Combined Orthopaedic and Neurosurgery Spine Program, Schulich School of Medicine, Western University, London, ON, Canada.
⁸ Department of Surgery, Division of Neurosurgery, Dalhousie University, Halifax, NS, Canada.
⁹ University of Calgary Spine Program, University of Calgary, Calgary, AB, Canada.
¹⁰ Department of Surgery, Division of Orthopaedics, Montreal General Hospital, McGill University, Montreal, QC, Canada.
¹¹ Département de Chirurgie, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada.
¹² Sault Area Hospital, Northern Ontario School of Medicine, Sault Ste Marie, Sault Ste. Marie, ON, Canada.
¹³ Centre de Recherche CHU de Quebec, CHU de Quebec-Universite Laval, Quebec City, QC, Canada.
¹⁴ Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver, BC, Canada.
¹⁵ Department of Orthopaedic Surgery, Health Sciences Centre, Newfoundland and Labrador, St. John's, Canada.
¹⁶ Department of Surgery, Division of Orthopedics, Dalhousie University, Halifax, NS, Canada.
¹⁷ Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, ON, Canada.
¹⁸ Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
¹⁹ Canada East Spine Centre, Division of Orthopaedic Surgery, Horizon Health Network, Zone 2, Saint John, New Brunswick, Canada.
²⁰ Dalhousie University Faculty of Medicine, Halifax, NS, Canada.
²¹ Department of Surgery, University of Toronto, Toronto, ON, Canada.
²² Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
²³ Schroeder Arthritis Institute, Krembil Research Institute, Department of Surgery, Division of Orthopaedic Surgery, University Health Network, University of Toronto, Orthopaedics, Toronto, ON, Canada. raja.rampersaud@uhn.ca.

^# Contributed equally.

PMID: 40450143
PMCID: PMC12126512
DOI: 10.1038/s41598-025-03613-4

Observational Study

The impact of elective spine surgery in Canada for degenerative conditions on patient reported health-related quality of life outcomes

Ragavan Manoharan et al. Sci Rep. 2025.

. 2025 May 31;15(1):19143.

doi: 10.1038/s41598-025-03613-4.

Authors

Affiliations

¹ University of Toronto Spine Program, Toronto Western Hospital, Toronto, ON, Canada.
² Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia.
³ Department of Neurosurgery, The Walton Centre, Liverpool, United Kingdom.
⁴ Faculty of Health and Life Sciences, University of Liverpool, Liverpool, England.
⁵ Division of Orthopaedic Surgery, Department of Surgery, CHU de Québec - Université Laval Quebec City, Quebec, QC, Canada.
⁶ Schroeder Arthritis Institute, Krembil Research Institute, Department of Surgery, Division of Orthopaedic Surgery, University Health Network, University of Toronto, Orthopaedics, Toronto, ON, Canada.
⁷ London Health Science Centre Combined Orthopaedic and Neurosurgery Spine Program, Schulich School of Medicine, Western University, London, ON, Canada.
⁸ Department of Surgery, Division of Neurosurgery, Dalhousie University, Halifax, NS, Canada.
⁹ University of Calgary Spine Program, University of Calgary, Calgary, AB, Canada.
¹⁰ Department of Surgery, Division of Orthopaedics, Montreal General Hospital, McGill University, Montreal, QC, Canada.
¹¹ Département de Chirurgie, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada.
¹² Sault Area Hospital, Northern Ontario School of Medicine, Sault Ste Marie, Sault Ste. Marie, ON, Canada.
¹³ Centre de Recherche CHU de Quebec, CHU de Quebec-Universite Laval, Quebec City, QC, Canada.
¹⁴ Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver, BC, Canada.
¹⁵ Department of Orthopaedic Surgery, Health Sciences Centre, Newfoundland and Labrador, St. John's, Canada.
¹⁶ Department of Surgery, Division of Orthopedics, Dalhousie University, Halifax, NS, Canada.
¹⁷ Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, ON, Canada.
¹⁸ Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
¹⁹ Canada East Spine Centre, Division of Orthopaedic Surgery, Horizon Health Network, Zone 2, Saint John, New Brunswick, Canada.
²⁰ Dalhousie University Faculty of Medicine, Halifax, NS, Canada.
²¹ Department of Surgery, University of Toronto, Toronto, ON, Canada.
²² Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
²³ Schroeder Arthritis Institute, Krembil Research Institute, Department of Surgery, Division of Orthopaedic Surgery, University Health Network, University of Toronto, Orthopaedics, Toronto, ON, Canada. raja.rampersaud@uhn.ca.

^# Contributed equally.

PMID: 40450143
PMCID: PMC12126512
DOI: 10.1038/s41598-025-03613-4

Abstract

The impact of spine surgery on Health-Related Quality-of-Life (HRQoL) outcomes across common spinal degenerative diagnoses is not well characterised. A prospective observational study of patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) registry was performed. Baseline and 1-year post-operative Short Form-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were collated and compared to normative values from the Canadian General Population (CGP). The percentage of patients achieving the PCS Minimum Clinically Important Difference (MCID) was quantified. 5049 patients were included in the analysis. The mean pre-operative SF-12 PCS was 29.5 and MCS was 44.1. This improved to a mean PCS of 40.5 (p < 0.001) and MCS of 49.3 (p < 0.0001) at 1-year post-operatively. The mean pre-operative PCS was over 2 standard deviations (SD) lower than the normative mean of the CGP; this improved to being close to 1-SD from the normative CGP mean at 1-year post-operatively. Findings were similar across age- and sex-stratified subgroups. Across all conditions, 70-75% of patients achieved the PCS MCID. Fewer patients with cervical myelopathy achieved the PCS MCID (59%). In a surgical cohort, patients with degenerative spinal conditions demonstrate a profound reduction in PCS compared to their peers in the CGP. Spinal surgery was impactful in improving physical function HRQoL outcomes in the majority, but not typically to average population norms.

Keywords: Degenerative spinal conditions; Spinal health-related quality of life outcomes; Spine surgery.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

**Fig. 1**
Flow diagram of the study cohort development. CSORN = The Canadian Spine Outcomes & Research Network. HRQoL = Short Form-12 Physical Component Score and Mental Component Score Health Related Quality of Life data.

**Fig. 2**
SF PCS & MCS histograms pre- and post-surgery compared to the normal Canadian population (25 + years).

**Fig. 3**
Percentage of patients with PCS at or above the CGP mean, within 1 SD below the mean, more than 1 but less than 2 SDs below the mean, and more than 2SDs below the mean. Values are provided pre- and post-surgery, and by age and sex subgroups.

**Fig. 4**
Charts depict the pre-op and post-op PCS and MCS by surgical region, age and sex, primary symptom, and diagnoses with the standard deviation provided as an error bar. The CGP mean is provided as the vertical red line for PCS and MCS respectively with the CGP standard deviation as a transparent grey box. Spondy = spondylolithesis, DDD = degenerative disc disease.

See this image and copyright information in PMC

References

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The impact of elective spine surgery in Canada for degenerative conditions on patient reported health-related quality of life outcomes

Affiliations

The impact of elective spine surgery in Canada for degenerative conditions on patient reported health-related quality of life outcomes

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical