Registry-based clinical research and quality improvement in spine surgery

NORspine has recorded more than 70 000 lumbar spine operations (since 2007) and more than 12 000 cervical spine operations (since 2012). We also record operations for deformities (from 2023).

The overreaching aim is to provide data for quality improvement and research. Generally, we perform prognosis research, relative effectiveness studies and health services research. We collaborate with large population-based epidemiological studies and registries in Norway and with national spine registries abroad (e.g. the Swedish Spine Registry (SWEspine)).

Specifically, we now aim to:

• Study predictors for failed and successful outcome after spine surgery, as well as prognostic modelling using classical statistical methods.
• Develop and AI-enabled decision support for lumbar spine surgery. This is described in detail as a separate project (AI enabled decision support for spine surgery).
• Evaluate costs and treatment effectiveness during implementation of endoscopy in spine surgery in Norway.
• Study temporal trends and geographic variation in the utilization of spine surgery, and factors associated with mobility across health regions and across the public- and private health sector.
• Study whether less complex surgery could be as good as more complex, costly and risky procedures, e.g. in the treatment of degenerative lumbar spondylolisthesis and degenerative cervical myelopathy (DCM).
• Study the prevalence of DCM in the 8th iteration of the Tromsø study (a population-based health-study). This will be in collaboration with the international RECODE-DCM. focusing on prioritized research questions in this field, and will include the establishment an observational cohort of patients with DCM to study the natural course of the disease.
• Conduct register-embedded randomised controlled trials

Principal investigator: Tore K. Solberg

Internal members: Tor Ingebrigtsen, Eirik Mikkelsen, Elisabet Danielsen, Lovise Hammer, Henrik Lykke Joakimsen, Samer Habiba

External collaborators: Øystein P. Nygaard and Sasha Gulati (Norwegian university for technology and science and National centre for surgical treatment of spinal disorders, St. Olavs university hospital, Trondheim, Norway), Mark Kotter and Benjamin Davies (Division of neurosurgery, Universiy of Cambridge, UK), Ivar Austevoll (Department of orthopedic surgery, Haukeland university hospital, Bergen, Norway), Jens Ivar Brox, John Anker Zwart, Kjersti Storheim and Christian Hellum (Oslo university Hospital and Oslo university, Norway), Beate Hauglann and Frank Olsen (Centre for clinical evaluation and documaentation, Northern Norway regional health authority, Tromsø, Norway), Peter Fritzell (Swespine registry, Sweden), Margreth Grotle (Oslo metropolitan university).

Read more about NORspine

Link to NORspine (in Norwegian)

Selected publications 2018-2022

1. Ingebrigtsen T, Aune G, Karlsen ME, Gulati S, Kolstad F, Nygaard ØP, Thyrhaug AM, Solberg TK. Non-respondents do not bias outcome assessment after cervical spine surgery: a multicenter observational study from the Norwegian registry for spine surgery (NORspine). Acta Neurochir (Wien). 2023;165:125-133. Epub 2022 Dec 21.
2. Mjåset C, Solberg TK, Zwart JA, Småstuen MC, Kolstad F, Grotle M. Anterior surgical treatment for cervical degenerative radiculopathy: a prediction model for non-success. Acta Neurochir (Wien). 2023;165:145-157. Epub 2022 Dec 8
3. Danielsen E, Mjåset C, Ingebrigtsen T, Gulati S, Grotle M, Rudolfsen JH, Nygaard ØP, Solberg TK. A nationwide study of patients operated for cervical degenerative disorders in public and private hospitals. Sci Rep. 2022;12:12856
4. Johansen TO, Vangen-Lønne V, Holmberg ST, Salvesen ØO, Solberg TK, Gulati AM, Nygaard ØP, Gulati S. Surgery for degenerative cervical myelopathy in the elderly: a nationwide registrybased observational study with patient-reported outcomes. Acta Neurochir (Wien). 2022;164:2317-2326
5. Hermansen E, Austevoll IM, Hellum C, Storheim K, Myklebust TÅ, Aaen J, Banitalebi H, Anvar M, Rekeland F, Brox JI, Franssen E, Weber C, Solberg TK, Furunes H, Grundnes O, Brisby H, Indrekvam K. Comparison of 3 different minimally invasive surgical techniques for lumbar spinal stenosis: a randomized clinical trial. JAMA Netw Open. 2022;5:e224291
6. Ingebrigtsen T, Guldhaugen KA, Kristiansen JA, Kloster R, Grotle M, Solberg TK. Cervical spine surgery in the Northern Norway Regional Health Authority area in 2014-18. Tidsskr Nor Laegeforen. 2022;142.
7. Holmberg ST, Fredheim OMS, Skurtveit S, Salvesen ØO, Nygaard ØP, Gulati AM, Solberg TK, Gulati S. Persistent use of prescription opioids following lumbar spine surgery: observational study with prospectively collected data from two Norwegian nationwide registries. Spine 2022; 47(8):607-614. Epub Nov. 18, 2021.
8. Austevoll IM, Hermansen E, Fagerland MW, Storheim K, Brox JI, Solberg T, Rekeland F, Franssen E, Weber C, Brisby H, Grundnes O, Algaard KRH, Böker T, Banitalebi H, Indrekvam K, Hellum C; NORDSTEN-DS Investigators. Decompression with or without fusion in degenerative lumbar spondylolisthesis. N Engl J Med 2021;385:526-538.
9. Gulati S, Vangen-Lønne V, Nygaard ØP, Gulati AM, Hammer TA, Johansen TO, Peul WC, Salvesen ØO, Solberg TK. Surgery for degenerative cervical myelopathy: a nationwide registry-based observational study with patient-reported outcomes. Neurosurgery 2021;89:704-711
10. Werner DAT, Grotle M, Småstuen MC, Gulati S, Nygaard ØP, Salvesen Ø, Ingebrigtsen T, Solberg TK. A prognostic model for failure and worsening after lumbar microdiscectomy: a multicenter study from the Norwegian Registry for Spine Surgery. Acta Neurochir 2021;163:2567-2580
11. Alhaug OK, Dolatowski FC, Solberg TK, Lønne G. Criteria for failure and worsening after surgery for lumbar spinal stenosis: a prospective national spine registry observational study. Spine J. 2021;21:1489-1496
12. Ingebrigtsen T, Balteskard L, Guldhaugen KA, Kloster R, Uleberg B, Grotle M, Solberg TK. Treatment rates for lumbar spine surgery in Norway and Northern Norway Regional Health Authority 2014-18. Tidsskr Nor Laegeforen 2020;140(17).
13. Austevoll IM, Gjestad R, Solberg T, Storheim K, Brox JI, Hermansen E, Rekeland F, Indrekvam K, Hellum C. Comparative Effectiveness of Microdecompression Alone vs Decompression Plus Instrumented Fusion in Lumbar Degenerative Spondylolisthesis. JAMA Netw Open. 2020;3(9):e2015015
14. Werner DAT, Grotle M, Gulati S, Austevoll IM, Madsbu MA, Lønne G, Solberg T. Can a successful outcome after surgery for lumbar disc herniation be defined by the Oswestry Disability Index Raw Score? Global Spine J 2019;10:47-54
15. Lønne G, Fritzell P, Hägg O, Nordvall D, Gerdhem P, Lagerbäck T, Andersen M, Eiskjaer S, Gehrchen M, Jacobs W, van Hooff ML, Solberg TK. Lumbar spinal stenosis: comparison of surgical practice variation and clinical outcome in three national spine registries. Spine J. 2019;41-49. Epub May 21, 2018

NORspine has permanent funding of it's routine data collection and operation from the Northern Norway regional health authority

Ph.d. grants from the Northern Norway Regional Health Authority (HNF1538-20 og HNF1717-24)