Purpose: Patient involvement and shared decision-making (SDM) are central to patient-centered care and have been linked to improved patient satisfaction and outcomes. However, their implementation in spinal surgery remains limited, and the effect of patient involvement on postoperative outcomes is not well described.
Methods: This observational cohort study used data from the Swedish Spine Registry (Swespine) to examine the association between perceived patient involvement in decision-making and postoperative outcomes among adults undergoing cervical spinal surgery between 2006 and 2020. Propensity score-matching was performed at a ratio of 2:1 to minimize baseline differences between groups. Uni- and multivariable analyses were conducted to identify factors associated with patient's perception of involvement in decision-making.
Results: A total of 3,249 patients were included, with 81% (n = 2,640) reporting perceived involvement in decision-making and 19% (n = 609) not. Following matching, patients who were involved in decision-making had significantly greater improvements at one year follow-up regarding neck and arm pain (p < 0.001), disability (p < 0.001), health-related quality of life (p < 0.001), and subjective satisfaction (p < 0.001). Patients with poorer preoperative health status are more likely to feel involved in decision making, while those undergoing minor procedures feel significantly less involved. Positive predictors of perceived patient involvement included number of operated levels (OR 1.13, p = 0.041), unemployment (OR 1.89, p < 0.001), walking less than 100 m at a normal pace (OR 1.45, p = 0.044), and higher preoperative NDI (OR 1.01, p = 0.039). Negative predictors included higher preoperative EQ-5D index (OR 0.64, p = 0.022) and higher preoperative myelopathy score (OR 0.96, p = 0.042).
Conclusion: Patients with a higher degree of perceived involvement report better postoperative patient-reported outcomes following cervical spinal surgery. Patients undergoing larger surgeries and with poorer preoperative health status were more likely to perceive involvement than those undergoing minor procedures. Identifying and supporting patients that are susceptible to feel less involved in treatment-related decisions through individualized information or counseling may help optimize outcomes and satisfaction.
Keywords: spine surgery; patient involvement; shared decision-making; informed consent; registry.
© 2025. The Author(s).