Differences in the Surgical Treatment of Recurrent Lumbar Disc Herniation Among Spine Surgeons in the United States

Abstract

BACKGROUND CONTEXT:

There are often multiple surgical treatment options for a spinal pathology. In addition, there is a lack of data that defines differences in surgical treatment among surgeons in the U.S.

PURPOSE:

To assess the surgical treatment patterns among neurological and orthopaedic spine surgeons in the United States for the treatment of one-and two-time recurrent lumbardisc herniation.

STUDY DESIGN:

Electronic Survey PATIENT SAMPLE: An electronic survey was delivered to 2560 Orthopaedic and Neurological surgeons in the U.S.

OUTCOME MEASURES:

The response data were analyzed to assess the differences among respondents over various demographic variables. The probability of disagreement is reported for various surgeon subgroups.

METHODS:

A survey of clinical and radiographic case scenarios that included a one- and two-time lumbar disc herniation was electronically delivered to 2560 Orthopaedic and Neurological surgeons in the U.S. The surgical treatment options were revision microdiscectomy, revision microdiscectomy with in-situ fusion, revision microdiscectomy with posterolateral fusion using pedicle screws, revision microdiscectomy with PLIF/TLIF, ALIF with percutaneous screws, ALIF with open posterior instrumentation, or none of the above. Significance of p=0.01 was used to account for multiple comparisons.

RESULTS:

445 surgeons (18%) completed the survey. Surgeons in practice 15+ years were more likely to select revision microdiscectomy compared with surgeons with fewer years in practice who were more likely to select revision microdiscectomy with PLIF/TLIF (p<0.001). Similarly, those surgeons performing 200+ surgeries per year were more likely to select revision microdiscectomy with PLIF/TLIF than those performing fewer surgeries (p=0.003). No significant differences were identified for region, specialty, fellowship training, or practice type. Overall, there was 69% and 22% probability that two randomly selected spine surgeons would disagree on the surgical treatment of two- and one-time recurrent discherniation, respectively. This probability of disagreement was consistent over multiple variables including geographic, practice type, fellowship training and annual case volume.

CONCLUSIONS:

Significant differences exist among U.S. spine surgeons in the surgical treatment of recurrent lumbar disc herniations. It will become increasingly important to understand the underlying reasons for these differences, and to define the most cost-effective surgical strategies for these common lumbar pathologies as the U.S. moves closer to a value-based health care system.

Copyright © 2014 Elsevier Inc. All rights reserved.

KEYWORDS:

disc herniation, electronic survey, practice trends, surgeon differences

PMID:

 

24462813

 

[PubMed - as supplied by publisher]