The first ever spinal trauma specific outcome tool published by AO Spine


09 September 2020

KF Trauma 2019
AO Spine KF Trauma at the Global Spine Congress 2019 in Toronto, ON, Canada

The AO Spine Knowledge Forum (KF) Trauma has developed and validated a universal outcome instrument specifically for spinal trauma patients. The patient reported spine trauma outcome measure (PROST) allows measuring and comparing different treatment options. Principal Investigator Cumhur Öner expects the system to be adopted universally for assessing the quality—or the change in the quality—of a patient's life.

"This is the first time in the history of spinal trauma we have a system that we can use to evaluate the progress and the quality of health of the spinal trauma patients specifically," Öner says.

Lead author Said Sadiqi agrees: "The outcomes of spine trauma patients have traditionally been limited to reporting of mortality and neurologic deficits or expressed with instruments designed for polytrauma patients or patients with chronic degenerative back pain."

How the study was done

In the first phase, the KF Trauma study identified health-related domains following the International Classification of Functioning, Disability and Health classification as reference. A consensus meeting agreed on a core set of categories that are most relevant to measure patient reported functioning, disability, and health outcomes. With the core set, they developed and validated a disease specific outcome instrument.

The AO Spine PROST has been validated in Dutch and has already been translated and culturally adapted into English, Slovak, Portuguese, German, French, Nepalese, and Egyptian, with translations into additional languages ongoing.

"In our recent studies, both the English and Dutch versions of the tool showed to be valid and reliable to measure outcomes in spine trauma patients," Sadiqi confirms. In both validation studies a convenient sample of more than 150 patients were included. "Excellent results were obtained for the validity, reliability as well as responsiveness of the tool."

Said Sadiqi
“The AO Spine PROST allows surgeons to follow-up on their patients in a valid and reliable fashion, but also to contribute to further evidence-based and patient-centered spine trauma care.”

Said Sadiqi

How to use the instrument, and why

The AO Spine PROST consists of 19 questions on a broad range of aspects of functioning on a 0–100 numeric rating scale. Sadiqi thinks it is a short, simple, and easy to administer patient-reported outcome measure. "A unique approach of the tool is asking the patients to compare their current function with the pre-injury level of function, with 0 indicating no function at all and 100 the pre-injury level of function."

Treating surgeons are encouraged to use the AO Spine PROST in the clinical setting as well as in research. "In the first line, this is going to assist trauma surgeons with the follow up of their patients," Öner confirms. "But this concept facilitates also spinal trauma research, making it possible to compare patient groups from different centers or different regions around the world."

Sadiqi sees clear benefits for spine trauma patients who would be able to quantify their recovery during follow-up after sustaining a traumatic spine injury. "Also, the use of the tool could contribute to the reduction of controversies on the optimal treatment of specific types of spine injury," Sadiqi continues. "For example, the AO Spine PROST is included as an outcome measure in an international AO Spine study to evaluate the best treatment for neurologically intact patients with burst fractures. Thus, the tool has the potential to lead to better treatment algorithms for patients with spine injuries."


Cumhur Oner
“This concept facilitates also spinal trauma research, making it possible to compare patient groups from different centers or different regions around the world.”

Principal Investigator Cumhur Öner

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