Forgotten Spine Surgery Score Cervical (FS3-C): A Patient-Reported Outcome Measure for Assessing the Impact of Motion Preservation in Cervical Spine Surgery

Study Design/Setting Prospective cohort study. Objectives To test whether the novel Forgotten Spine Surgery Score-Cervical (FS3-C) better differentiates outcomes between motion-preserving cervical disc replacement (CDR) and fusion via anterior cervical discectomy and fusion (ACDF) compared with the NDI. Methods The FS3-C was derived from a 20-item pool and reduced to 12 items after pilot testing in 41 CDR patients. Validation cohorts included 127 CDR and 112 ACDF patients who completed FS3-C and NDI. Internal consistency, ceiling/floor effects, and convergent validity were assessed. Group comparisons used appropriate parametric and nonparametric tests. Multivariable linear regression adjusting for age, Charlson Comorbidity Index, sex, and number of operated levels, as well as propensity score matching, were performed to address baseline differences. Results A total of 239 patients were included. Cronbach α was 0.95 (FS3-C) and 0.88 (NDI). FS3-C correlated inversely with NDI (r = −0.606, P < 0.001). Mean FS3-C was higher after CDR (59.9 ± 19.6) than ACDF (53.2 ± 22.2; P = 0.012), while NDI did not differ ( P = 0.074). In multivariable analysis, CDR remained independently associated with higher FS3-C scores (β = 8.94, P = 0.009), with no association for NDI ( P = 0.239). Propensity-matched analysis yielded consistent results (mean difference 9.22, P = 0.008), while NDI remained nonsignificant ( P = 0.289). Conclusions The FS3-C detected differences between CDR and ACDF not detected by the NDI. Findings were consistent across adjusted and propensity-matched analyses, supporting its strong performance and greater discriminatory capacity as a cervical spine PROM.