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Multicenter prospective pilot study.To evaluate if continuous physical activity monitoring by a personal electronic 3-dimensional accelerometer device is feasible and can provide objective data that correlates with patient-reported outcomes following spine surgery.Self-reported health-related quality-of-life (HRQOL) metrics are inherently limited by being very subjective, having a low frequency of data collection, and inconsistent follow-up.Inclusion criteria: adults (18+), thoracolumbar deformity or degenerative disease, and regular access to a computer with internet connection. Physical activity parameters included: number of daily steps, maximum hourly steps, and activity intensity. Patients completed the Oswestry Disability Index (ODI), the Short-Form Health Survey 36 (SF-36), and the Scoliosis Research Society-22r (SRS22) preoperatively and postoperatively at 6 weeks, 3 months, and 6 months.Thirty-two patients were enrolled, 8 (25%) withdrew, 1 (3.1%) died, and 1 (3.1%) did not end up undergoing surgery resulting in 22 (68.8%) available patients. Mean preoperative and postoperative step ranges were 1278±767 to 17,800±6464 and 891±587 to 12,655±7038, respectively. Eleven patients improved in mean total daily steps at the final postoperative month with 2 having significant improvements (P<0.05). Five patients did not significantly change (P>0.05) and 6 patients had significantly lower mean total daily steps at 6 months (P<0.05). The entire cohort significantly improved in ODI, SF-36 Physical Component Summary, SRS Activity, SRS Appearance, SRS Mental, SRS Satisfaction, and SRS Total score at 6 months postoperative (P<0.05 for all). Both ODI and Physical Component Summary were significantly correlated with preoperative average total daily steps (r=−0.61, P=0.0058 and r=0.60, P=0.0114, respectively). No other HRQOL metrics were significantly correlated at baseline or at 6 months postoperative (P>0.05).A prospective pilot study for continuous real-time physical activity monitoring was successfully completed. This is the first study of its kind and demonstrates a foundation to continuous physical activity monitoring following spine surgery. A larger and longer prospective study is needed to confirm long-term results and its relationship with HRQOL scores.