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 A.
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
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
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U2 - 10.1097/01.brs.0000181056.76595.f7
DO - 10.1097/01.brs.0000181056.76595.f7
M3 - Article
C2 - 16205349
AN - SCOPUS:26444438098
SN - 0362-2436
VL - 30
SP - 2214
EP - 2219
JO - Spine
JF - Spine
IS - 19
ER -