Online Sustained-Attention Testing as an Adjunct Outcome Measure in Personalized Spine Surgery Research: A Study Protocol and Methodological Framework Using the 90-Second CVAT

Background/Objectives: This protocol article presents a methodological framework and does not itself report a new validation dataset. Personalized spine surgery increasingly requires outcome measures that capture recovery domains beyond pain, disability, imaging, neurological status, complications, and revision surgery. Sustained-attention instability may reflect pain-related cognitive burden and may influence rehabilitation adherence, work capacity, medication management, and postoperative self-care. Building on published CVAT evidence and additional unpublished findings from a completed independent online known-groups cohort, this protocol article specifies a standardized framework for integrating the online 90 s Continuous Visual Attention Test (CVAT) into personalized spine surgery research. Methods: The proposed protocol combines conventional clinical-outcome assessment, patient-reported outcome measures, and repeated online CVAT testing at baseline and follow-up. Its primary implementation is a prospective, longitudinal observational cohort using a harmonized common core; disease-specific modules prospectively specify the diagnosis, procedure, clinical endpoint, sample size, and analysis. Prospective studies should define baseline as the first protocol-specified CVAT assessment, preferably before surgery or another index intervention. Retrospective and registry-based cohorts may support cross-sectional analyses or prospective trajectories beginning at digital enrollment when no preintervention CVAT measurement is available. Candidate spine cohorts include lumbar disk herniation, cervical disk herniation/radiculopathy, cervical myelopathy, lumbar spinal stenosis, and expanded postoperative or revision cohorts. The primary CVAT performance endpoint is variability of reaction time (VRT); VRT/RT is a key secondary and sensitivity endpoint, while mean reaction time (RT), omission errors, and commission errors are secondary endpoints. Protocol Components: Existing peer-reviewed evidence supports the brief CVAT paradigm, chronic-spine-pain known-groups discrimination, and remote administration; additional completed online data independently reproduced the principal VRT and VRT/RT pattern in chronic spine pain. The protocol specifies eligibility criteria, task parameters, scoring and preprocessing, remote-testing procedures, tokenized access, device and input-method documentation, session-validity checks, feasibility outcomes, exploratory responder and non-responder definitions, longitudinal assessment schedules, sample-size examples, missing-data and multiplicity procedures, and a staged pathway from established foundations to postoperative prognostic and clinical-utility evaluation. Conclusions: The online 90 s CVAT has an empirical foundation as a brief, remotely deployable performance-based measure and is proposed as an adjunct—not a replacement for PROMs, examination, imaging, or clinical judgment. Prospective spine surgery validation is required to establish postoperative reliability, responsiveness, meaningful-change thresholds, incremental prognostic value, and clinical utility; paired technical studies remain necessary when strict cross-platform interchangeability is claimed.