A digital care and outcomes network for endoscopic spine surgery: design, implementation, and early performance of a next-generation multicenter registry.

OBJECTIVE

Prospective spine registries such as the National Neurosurgery Quality and Outcomes Database (N2QOD) have established the value of multicenter outcomes monitoring for quality improvement in spine care. However, conventional registry architectures were designed primarily for long-term benchmarking after traditional fusion procedures, and they remain resource intensive, coordinator dependent, and structurally limited in their capacity to capture the immediate postoperative period. This limitation is particularly consequential for endoscopic and minimally invasive spine surgery, where clinically meaningful recovery unfolds rapidly and predominantly outside the hospital. Endoscopic procedures demand a fundamentally different registry approach: ultra-early measurement of pain, wound status, and function during the front-loaded outpatient recovery arc. Here, the authors evaluated SPINEHealthie, a care-integrated digital platform designed specifically for high-frequency, patient-directed data acquisition during the critical first postoperative weeks after endoscopic spine surgery.

METHODS

SPINEHealthie is a smartphone application integrating structured patient-reported outcome measures (PROMs), asynchronous patient-provider communication, virtual wound surveillance, and active care delivery. The platform is governed by the Endoscopic Spine Research Group (ESRG), a multicenter consortium of 24 surgeons across 17 IRB-approved institutions. Between 2021 and 2025, 1656 patients were enrolled. The authors analyzed participation rates, PROM compliance, and paired baseline to 3-month outcomes across cervical (n = 156) and thoracolumbar (n = 1500) modules.

RESULTS

Enrollment feasibility was high: 91.0% of eligible patients participated, with 85.0% completing postoperative PROMs. Sixty-seven percent (67.0%) completed ≥ 5 PROMs within postoperative week 1; 53.2% submitted wound images. Cumulative data volume reached 142,484 data points. Paired baseline to 3-month outcomes demonstrated consistent improvements across all procedures and both modules. Platform-supported care delivery was associated with reduced clinic utilization and fewer emergency department visits.

CONCLUSIONS

SPINEHealthie closes a key visibility gap in the early postoperative course after ambulatory endoscopic spine surgery by enabling remote, high-frequency measurement integrated with active care delivery. Conventional registries optimize for long-term benchmarking after traditional spine procedures; SPINEHealthie optimizes for ultra-early outpatient recovery surveillance after tissue-sparing surgery. These findings demonstrate that purpose-built digital registries can meaningfully advance quality improvement and patient safety in endoscopic spine surgery by capturing the rapid-recovery trajectories that traditional systems were not designed to assess.