Use of the Patient-Reported Outcomes Measurement Information System (PROMIS) Outcome Measures in Lumbar Decompression Surgery: A Systematic Review

Degenerative lumbar spine diseases are a major cause of disability and may require surgical intervention when conservative management fails. Patient-reported outcome measures are commonly used to assess postoperative recovery following lumbar decompression. Traditional instruments such as the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), and Short Form Health Surveys are widely used but have limitations, including fixed length and ceiling effects. The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to address these limitations through standardized domains and adaptive testing. Although PROMIS has increasingly been used in spine surgery research, the literature on lumbar decompression remains heterogeneous. A systematic review was conducted according to the PRISMA 2020 guidelines to evaluate the use of PROMIS outcome measures in lumbar decompression surgery. PubMed, Embase, and Scopus were searched for English-language studies published between January 2010 and January 2026. Eligible studies included adult patients undergoing lumbar decompression for degenerative lumbar spine conditions reporting PROMIS outcomes. Extracted data included study characteristics, PROMIS domains, follow-up duration, analytical approaches, and key findings related to postoperative responsiveness, clinically meaningful improvement, predictive utility, and correlations with legacy outcome measures. Due to heterogeneity in PROMIS domains, follow-up intervals, and analytical methods, results were synthesized qualitatively. Forty-five studies comprising 13,444 patients met the inclusion criteria. Most studies were retrospective cohort studies (43/45), conducted in the United States (43/45), and performed at single institutions (41/45). PROMIS Physical Function (PF) was the most frequently evaluated domain, appearing in 42 studies. Pain-related domains such as pain interference and pain intensity were also commonly assessed, while psychological and global health domains were evaluated less frequently. Overall, 40 studies (88.9%) reported postoperative improvement in at least one PROMIS domain following lumbar decompression. Minimal clinically important difference (MCID) analyses were reported in 32 studies (71.1%). Sixteen studies (35.6%) evaluated PROMIS measures as predictors of postoperative outcomes, while 11 studies (24.4%) reported correlations with legacy outcome instruments such as ODI and VAS. PROMIS PF consistently demonstrated responsiveness to postoperative improvement and moderate to strong correlations with traditional outcome measures. PROMIS outcome measures appear to be a useful framework for evaluating recovery following lumbar decompression surgery. PROMIS PF and pain-related domains demonstrate responsiveness to postoperative improvement and show moderate to strong correlations with established legacy instruments. Emerging evidence suggests that PROMIS scores may have potential prognostic value in assessing postoperative recovery trajectories. However, the current literature is characterized by substantial heterogeneity in PROMIS domain selection, MCID reporting, and analytical methodology, and is predominantly based on retrospective cohort studies. As such, these findings should be interpreted in the context of these limitations, and further methodological standardization and prospective research are needed to better define the role of PROMIS in lumbar spine surgery outcome assessment.