Aebi, M.

Grob, D.

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Eur Spine J (2004) 13:661-662DOI 10.1007/s005 86-004-0868-0M. Aebi SSE Spine Tango:D. Groba European Spine Registry promotedby the Spine Society of Europe (SSE)Received: 14 December 2004Accepted: 14 December 2004Published online: 22 December 2004© Springer-Verlag 2004It is increasingly understood that, inany technology-driven surgical disci-pline, patients should be documentedand registered in a standardized wayif they are recipients of novel inven-tions and implants. This is to have acommon language for reporting out-comes, complications and unfore-seen incidents which can be betterrecognized in a large, common datapool serving as an early warning sys-tem. There is a call for such reg-istries, since we know about theirvalue in the fields of hip and kneearthroplasty. It is obvious that theseendeavors are not only of benefit forthe industry producing such technol-ogy but also even more so for sur-geons when dealing with insuranceand governmental regulatory bodies.Such a project is, therefore, in thevery best interest of surgeons andphysicians who make use of rapidlychanging technologies to accomplishtheir treatment strategies, and it can-not be sufficiently emphasized thatwe have to drive this agenda if wedo not want to risk being driven bythird parties.It is for these reasons that someproponents of the SSE have initiateda European Spine Registry, calledSpine Tango, and have convinced theSociety to form a Spine Tango Com-mittee, which was assigned with theimplementation of such a registry.Looking back, the development ofSpine Tango has taken several years.During that time, a comprehensiveknow-how regarding content and thetechnological implementation ofsuch a system has been gathered.The Spine Tango 2004 represents theessence of our experiences, whichhave had a major influence on theway this registry is constructed to-day. The primary ambitious goal, toinclude all pathologies of the spine,including all levels, approaches andprocedures, resulted in an extremelycomplex electronic questionnaire,which could be navigated with an"intelligent" Internet application.The system only displayed the rele-vant questions to the users, whereascontent not applying to the respec-tive case remained hidden in thebackground. This first version ofSpine Tango required users with anadvanced knowledge of web applica-tions and many of our colleaguesfailed with it because of the com-plexity and time constraints. Unfor-tunately, we doctors quickly con-demn things without really havingunderstood them.Nevertheless, since 2002 data setsof more than 2,500 surgical interven-tions and more than 1,000 follow-upexaminations have been collectedwith the first version of Spine Tangoand by that the feasibility of the sys-tem was clearly proven. The profileof the participating pilot clinicsshowed, however, that this projectwas mainly suitable for academiccenters with a corresponding infra-structure and staff support, and lessM. Aebi (®)Institute for Evaluative Researchin Orthopaedic Surgery,University of Bern,Stauffacherstrasse 78, 3014 Bern,Switzerlande-mail: max.aebi@MEMcenter.unibe.chD. GrobSpine Center,Schulthess Klinik,Lengghalde 2, 8008 Zuerich,Switzerland662appropriate for poorly equipped pio-neers and believers in documenta-tion.Besides the problems with contentand technology, an additional issuearose, which was taken very serious-ly by the committee: though manda-tory demographic data for the cre-ation of an online patient chart wasminimal, electronically transferringthis data across regional or nationalborders conflicted with regulationsabout patient privacy in some coun-tries, if written informed consent wasnot given by patients or their fami-lies.These are important aspects for aEuropean registry with a multitudeof different legislations and they ini-tiated and stimulated research anddevelopment of a completely newtechnology for the Spine Tango inorder to address the legal concernsand make it usable for everybody.The Institute for Evaluative Re-search in Orthopaedic Surgery at theUniversity of Bern has introducedthe concept of so-called documenta-tion modules, which are little PCweb-servers that are placed inside acountry or a participating institutionand act as filters for all data identify-ing users and patients. The respectivedata sets are stored in the databaseof the local module, whilst theanonymized medical questionnairesare passed on to the central Europeandatabase labeled with a key (seeJBJS, 86A(9):2077-2080, 2004). Inaddition, each module has its ownInternet address and serves as en-trance gate to the documentationnetwork for all institutions belongingto a specific country (e.g. http://www. spinetango. au stria. com,http://www.spinetango.finland.com,etc.). Hence, only "raw" medicaldata sets leave national boundaries.This allows two things: an indi-vidual institution can either directlyjoin the central database of the SpineSociety of Europe through its webpage, or it joins the national moduleof its country, which will be adminis-tered by an academic institution or anational spine organization. As cur-rently planned, those who want touse the SSE Spine Registry can go tothe society web page and follow alink to Spine Tango or directly go tohttp://www.spinetango.com. In caseswhere a national module was in-stalled, users can go to the web ad-dress of this module or follow a linkon the web page of their national so-ciety. The first countries to beequipped with modules are Austria,England, and Finland. For Swissusers, the SSE module is the nationalmodule.In long discussions, statisticalevaluations and test runs, a coredataset has been worked-out fromthe original pool of questions stillfulfilling the goal of covering thewide spectrum of pathologies andsurgeries of the spine. In addition, apaper-based version of the question-naire was designed for all those, whoprefer this mode of data capture overthe online questionnaire.The double-sided A4 primaryquestionnaire and the single-sidedA4 follow-up questionnaire can becompleted with a no. 2 pencil andtransferred to the central database bymeans of an optical mark reader(OMR scanner) connected to a PCand operated using the web interface.Therefore, data collection in a spineunit or a hospital can either be con-ducted online or offline (paper-based). The physician-administeredforms are completed by surgeons andmedical staff; administration of thequestionnaires should be done bysecretaries, research nurses or othernon-medical persons, either in thedepartment or in a centralized office(e.g., that of a national society).It is obvious that those centers us-ing the paper-based solution eitherneed their own scanner or the possi-bility of sending their questionnairesby regular mail to a facility offeringscanning services (for a small fee).Depending on how many users areinterested in such a set-up, the SpineSociety of Europe is going to estab-lish its own central scanning service.The registry manual can be foundon http://www.eurospine.org (link toSpine Tango Registry) or directly un-der http://www.spinetango.comIn conclusion, a sophisticated anduser-friendly technology has beendeveloped to centrally host the firstofficial and comprehensive EuropeanSpine Registry, taking into accountthe heterogeneity of needs and regu-lations. It will enable us to establishand use the same language and datastructure for the assessment of treat-ments and outcomes and to createEuropean benchmarks for state of theart spine surgery. We encourage allreaders and SSE members to join thisambitious and challenging project,either directly through the SSE webpage or through one of the hopefullyincreasingly installed national mod-ules.

SSE Spine Tango: a European Spine Registry promoted by the Spine Society of Europe (SSE)

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SSE Spine Tango: a European Spine Registry promoted by the Spine Society of Europe (SSE)

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