The Single Assessment Numeric Evaluation (SANE) after anterior cervical discectomy and fusion: A pilot study

Scott C. Wagner, Ahmad Nassr, Brett A. Freedman, Benjamin D. Elder, Mohamad Bydon, Arjun S. Sebastian

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Study design: Retrospective cohort. Objectives: To evaluate the single assessment numerical evaluation (SANE) as a patient reported outcomes measure (PROM) after anterior cervical discectomy and fusion (ACDF), by comparing to legacy measures. Methods: We included all patients undergoing ACDF with at least one year of follow up with complete PROM data. Patients completed the Neck Disability Index (NDI), the RAND-36 and the EuroQual Five Dimension (EQ-5D) scale, as well as the one-question SANE, pre- and post-operatively. Validity of SANE compared with other PROMs was determined utilizing Pearson's correlation (ρ), proportional bias (B), responsiveness, minimal clinically important difference (MCID) and agreement. Results: Sixty-nine patients were included. There were moderate-to-strong correlations at a minimum of one-year follow-up between the SANE and NDI (ρ = −0.73, P < 0.0001), RAND (ρ = 0.80, P < 0.0001), and EQ-5D (ρ = −0.66, P < 0.0001). No significant proportional bias was found for the SANE when compared to the RAND (B = 0.03, p = 0.99), NDI (B = −0.003, p = 0.99), or EQ-5D (B = −0.0007, p = 0.99). Responsiveness for SANE was statistically similar to all other PROMs. The MCID for SANE was determined to be 10.5, with 42% of patients achieving the MCID. Bland-Altman plots demonstrated high agreement between all PROMs. Conclusion: We found the SANE score provides clinically important patient outcomes data after ACDF, despite only requiring answering one question. The SANE performs comparably to more burdensome health questionnaires. The SANE score may offer spine surgeons the option to easily and quickly collect clinically relevant data on their surgical patients.

Original languageEnglish
Pages (from-to)95-101
Number of pages7
JournalJournal of Clinical Neuroscience
StatePublished - Jun 2021
Externally publishedYes


  • ACDF
  • Outcomes
  • PROM
  • SANE


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