Value-based medicine (VBM) has emerged to integrate patient preferences and cost-effectiveness with research evidence since evidence-based medicine alone is not always sufficient for making rational clinical judgments [1]. However, in the case of posterior longitudinal ligament ossification of the spine (OPLL), current treatment recommendations are based solely on scientific evidence and do not consider patient values [2]. This is because there is limited information on patient values regarding OPLL treatment.

Recently, patient-reported outcome measures (PROMs) have been used to determine the effectiveness of treatments for OPLL. The JOACMEQ (Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire), SF-36® (MOS 36-Item Short-Form Health Survey), and EQ-5D (EuroQol 5 Dimension) have been frequently used to understand subjective symptoms, activity of daily living, and quality of life (QOL) in patients with OPLL. The JOACMEQ was developed using factor analysis and other quantitative psychological techniques and has proven to be a useful measure for verifying the effects of treatment on symptoms and QOL in patients with OPLL [3,4]. However, PROMs ratings do not directly reflect patient satisfaction with the treatment.

Patients with OPLL often experience residual pain and numbness in the limbs and trunk after surgery [5]; therefore, they may not always be satisfied with current treatment methods. Therefore, this study investigated patient satisfaction with surgery and drug treatment in terms of improvement in subjective symptoms such as pain and numbness. One of the unique features of this study is the use of the Patient and Public Involvement (PPI) principle, in which a questionnaire survey was administered to patients by patient representatives, enabling us to capture the true patient perspective. The survey was conducted amongst members of the OPLL Patient Association, which means that the majority of patients presented relatively severe disease. Although this implies a selection bias, the results of this survey nevertheless provide important information regarding first-hand opinions from OPLL patients. The primary aim of this study was to determine whether current surgical and drug therapies are truly valuable to patients and identify problems with current treatments.