Variation in surgical decision making for degenerative spinal disorders. Part II: Cervical spine

Zareth N. Irwin, Alan Hilibrand, Michael Gustavel, Robert McLain, William Shaffer, Mark Myers, John Glaser, Robert Hart

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Study Design. Survey-based descriptive study. Objective. To study relationships between surgeon-specific factors and surgical approach to degenerative diseases of the cervical spine. Summary of Background Data. Geographic variations in the rates of cervical spine surgery are significant within the United States. Although surgeon density correlates with the rates of spinal surgery, other reasons for variation such as surgeon-specific factors are poorly understood. Methods. A total of 22 orthopedic surgeons and 8 neurosurgeons of varied ages and geographic regions answered questions regarding the need for surgery, surgical approach, and use of fusion and instrumentation for 5 simulated cases. Cases included: (1) single-level disc herniation with osteophyte and radicutopathy, (2) single-level pseudarthrosis with axial neck pain, (3) multilevel stenosis with radiculopathy and neutral lordosis, (4) multilevel stenosis with myelopathy and neutral lordosis, and (5) multilevel stenosis with myetopathy and marked kyphosis. The effects of surgeon age and training background on surgical decision making were analyzed using an independent samples t test and Fisher exact test, respectively. Results. The greatest agreement occurred for the single-level disc herniation, with all surgeons choosing an anterior discectomy, end 28 of the 29 respondents recommending fusion. Younger surgeons recommended instrumentation more often for all cases, reaching significance for the case of multilevel stenosis with myelopathy and neutral lordosis (Fisher exact test P = 0.02). Differences in recommendation for fusion, instrumentation, and the use of a posterior approach between orthopedic and neurosurgeons were limited. Conclusions. Variations in surgical procedures for cervical degenerative disease may depend on the clinical condition. Although this study found strong agreement in treatment approach to single-level disc herniation, significant variation was seen for the other degenerative conditions of the cervical spine, While differences in recommendation for fusion were not clearly associated with surgeon age, there was a trend toward the higher use of instrumentation by younger surgeons. Previously documented geographic variation may result in part from a lack of consensus regarding appropriate treatment techniques for certain degenerative conditions of the cervical spine, as well as surgeon-specific factors.

Original languageEnglish (US)
Pages (from-to)2214-2219
Number of pages6
JournalSpine
Volume30
Issue number19
DOIs
StatePublished - Oct 1 2005

Fingerprint

Decision Making
Spine
Lordosis
Pathologic Constriction
Spinal Cord Diseases
Surgeons
Osteophyte
Diskectomy
Kyphosis
Pseudarthrosis
Radiculopathy
Neck Pain
Orthopedics
Consensus
Therapeutics

Keywords

  • Cervical fusion
  • Cervical myelopathy
  • Cervical radiculopathy
  • Kyphosis
  • Spine instrumentation
  • Surgical variation

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Irwin, Z. N., Hilibrand, A., Gustavel, M., McLain, R., Shaffer, W., Myers, M., ... Hart, R. (2005). Variation in surgical decision making for degenerative spinal disorders. Part II: Cervical spine. Spine, 30(19), 2214-2219. https://doi.org/10.1097/01.brs.0000181056.76595.f7

Variation in surgical decision making for degenerative spinal disorders. Part II : Cervical spine. / Irwin, Zareth N.; Hilibrand, Alan; Gustavel, Michael; McLain, Robert; Shaffer, William; Myers, Mark; Glaser, John; Hart, Robert.

In: Spine, Vol. 30, No. 19, 01.10.2005, p. 2214-2219.

Research output: Contribution to journalArticle

Irwin, ZN, Hilibrand, A, Gustavel, M, McLain, R, Shaffer, W, Myers, M, Glaser, J & Hart, R 2005, 'Variation in surgical decision making for degenerative spinal disorders. Part II: Cervical spine', Spine, vol. 30, no. 19, pp. 2214-2219. https://doi.org/10.1097/01.brs.0000181056.76595.f7
Irwin ZN, Hilibrand A, Gustavel M, McLain R, Shaffer W, Myers M et al. Variation in surgical decision making for degenerative spinal disorders. Part II: Cervical spine. Spine. 2005 Oct 1;30(19):2214-2219. https://doi.org/10.1097/01.brs.0000181056.76595.f7
Irwin, Zareth N. ; Hilibrand, Alan ; Gustavel, Michael ; McLain, Robert ; Shaffer, William ; Myers, Mark ; Glaser, John ; Hart, Robert. / Variation in surgical decision making for degenerative spinal disorders. Part II : Cervical spine. In: Spine. 2005 ; Vol. 30, No. 19. pp. 2214-2219.
@article{27b05e4695a145838df48909ce941fb5,
title = "Variation in surgical decision making for degenerative spinal disorders. Part II: Cervical spine",
abstract = "Study Design. Survey-based descriptive study. Objective. To study relationships between surgeon-specific factors and surgical approach to degenerative diseases of the cervical spine. Summary of Background Data. Geographic variations in the rates of cervical spine surgery are significant within the United States. Although surgeon density correlates with the rates of spinal surgery, other reasons for variation such as surgeon-specific factors are poorly understood. Methods. A total of 22 orthopedic surgeons and 8 neurosurgeons of varied ages and geographic regions answered questions regarding the need for surgery, surgical approach, and use of fusion and instrumentation for 5 simulated cases. Cases included: (1) single-level disc herniation with osteophyte and radicutopathy, (2) single-level pseudarthrosis with axial neck pain, (3) multilevel stenosis with radiculopathy and neutral lordosis, (4) multilevel stenosis with myelopathy and neutral lordosis, and (5) multilevel stenosis with myetopathy and marked kyphosis. The effects of surgeon age and training background on surgical decision making were analyzed using an independent samples t test and Fisher exact test, respectively. Results. The greatest agreement occurred for the single-level disc herniation, with all surgeons choosing an anterior discectomy, end 28 of the 29 respondents recommending fusion. Younger surgeons recommended instrumentation more often for all cases, reaching significance for the case of multilevel stenosis with myelopathy and neutral lordosis (Fisher exact test P = 0.02). Differences in recommendation for fusion, instrumentation, and the use of a posterior approach between orthopedic and neurosurgeons were limited. Conclusions. Variations in surgical procedures for cervical degenerative disease may depend on the clinical condition. Although this study found strong agreement in treatment approach to single-level disc herniation, significant variation was seen for the other degenerative conditions of the cervical spine, While differences in recommendation for fusion were not clearly associated with surgeon age, there was a trend toward the higher use of instrumentation by younger surgeons. Previously documented geographic variation may result in part from a lack of consensus regarding appropriate treatment techniques for certain degenerative conditions of the cervical spine, as well as surgeon-specific factors.",
keywords = "Cervical fusion, Cervical myelopathy, Cervical radiculopathy, Kyphosis, Spine instrumentation, Surgical variation",
author = "Irwin, {Zareth N.} and Alan Hilibrand and Michael Gustavel and Robert McLain and William Shaffer and Mark Myers and John Glaser and Robert Hart",
year = "2005",
month = "10",
day = "1",
doi = "10.1097/01.brs.0000181056.76595.f7",
language = "English (US)",
volume = "30",
pages = "2214--2219",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "19",

}

TY - JOUR

T1 - Variation in surgical decision making for degenerative spinal disorders. Part II

T2 - Cervical spine

AU - Irwin, Zareth N.

AU - Hilibrand, Alan

AU - Gustavel, Michael

AU - McLain, Robert

AU - Shaffer, William

AU - Myers, Mark

AU - Glaser, John

AU - Hart, Robert

PY - 2005/10/1

Y1 - 2005/10/1

N2 - Study Design. Survey-based descriptive study. Objective. To study relationships between surgeon-specific factors and surgical approach to degenerative diseases of the cervical spine. Summary of Background Data. Geographic variations in the rates of cervical spine surgery are significant within the United States. Although surgeon density correlates with the rates of spinal surgery, other reasons for variation such as surgeon-specific factors are poorly understood. Methods. A total of 22 orthopedic surgeons and 8 neurosurgeons of varied ages and geographic regions answered questions regarding the need for surgery, surgical approach, and use of fusion and instrumentation for 5 simulated cases. Cases included: (1) single-level disc herniation with osteophyte and radicutopathy, (2) single-level pseudarthrosis with axial neck pain, (3) multilevel stenosis with radiculopathy and neutral lordosis, (4) multilevel stenosis with myelopathy and neutral lordosis, and (5) multilevel stenosis with myetopathy and marked kyphosis. The effects of surgeon age and training background on surgical decision making were analyzed using an independent samples t test and Fisher exact test, respectively. Results. The greatest agreement occurred for the single-level disc herniation, with all surgeons choosing an anterior discectomy, end 28 of the 29 respondents recommending fusion. Younger surgeons recommended instrumentation more often for all cases, reaching significance for the case of multilevel stenosis with myelopathy and neutral lordosis (Fisher exact test P = 0.02). Differences in recommendation for fusion, instrumentation, and the use of a posterior approach between orthopedic and neurosurgeons were limited. Conclusions. Variations in surgical procedures for cervical degenerative disease may depend on the clinical condition. Although this study found strong agreement in treatment approach to single-level disc herniation, significant variation was seen for the other degenerative conditions of the cervical spine, While differences in recommendation for fusion were not clearly associated with surgeon age, there was a trend toward the higher use of instrumentation by younger surgeons. Previously documented geographic variation may result in part from a lack of consensus regarding appropriate treatment techniques for certain degenerative conditions of the cervical spine, as well as surgeon-specific factors.

AB - Study Design. Survey-based descriptive study. Objective. To study relationships between surgeon-specific factors and surgical approach to degenerative diseases of the cervical spine. Summary of Background Data. Geographic variations in the rates of cervical spine surgery are significant within the United States. Although surgeon density correlates with the rates of spinal surgery, other reasons for variation such as surgeon-specific factors are poorly understood. Methods. A total of 22 orthopedic surgeons and 8 neurosurgeons of varied ages and geographic regions answered questions regarding the need for surgery, surgical approach, and use of fusion and instrumentation for 5 simulated cases. Cases included: (1) single-level disc herniation with osteophyte and radicutopathy, (2) single-level pseudarthrosis with axial neck pain, (3) multilevel stenosis with radiculopathy and neutral lordosis, (4) multilevel stenosis with myelopathy and neutral lordosis, and (5) multilevel stenosis with myetopathy and marked kyphosis. The effects of surgeon age and training background on surgical decision making were analyzed using an independent samples t test and Fisher exact test, respectively. Results. The greatest agreement occurred for the single-level disc herniation, with all surgeons choosing an anterior discectomy, end 28 of the 29 respondents recommending fusion. Younger surgeons recommended instrumentation more often for all cases, reaching significance for the case of multilevel stenosis with myelopathy and neutral lordosis (Fisher exact test P = 0.02). Differences in recommendation for fusion, instrumentation, and the use of a posterior approach between orthopedic and neurosurgeons were limited. Conclusions. Variations in surgical procedures for cervical degenerative disease may depend on the clinical condition. Although this study found strong agreement in treatment approach to single-level disc herniation, significant variation was seen for the other degenerative conditions of the cervical spine, While differences in recommendation for fusion were not clearly associated with surgeon age, there was a trend toward the higher use of instrumentation by younger surgeons. Previously documented geographic variation may result in part from a lack of consensus regarding appropriate treatment techniques for certain degenerative conditions of the cervical spine, as well as surgeon-specific factors.

KW - Cervical fusion

KW - Cervical myelopathy

KW - Cervical radiculopathy

KW - Kyphosis

KW - Spine instrumentation

KW - Surgical variation

UR - http://www.scopus.com/inward/record.url?scp=26444438098&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=26444438098&partnerID=8YFLogxK

U2 - 10.1097/01.brs.0000181056.76595.f7

DO - 10.1097/01.brs.0000181056.76595.f7

M3 - Article

C2 - 16205349

AN - SCOPUS:26444438098

VL - 30

SP - 2214

EP - 2219

JO - Spine

JF - Spine

SN - 0362-2436

IS - 19

ER -