Are lumbar fusion guidelines followed? A survey of north American spine surgeons

Thiago S. Montenegro, Christopher Elia, Kevin Hines, Zorica Buser, Jefferson Wilson, Zoher Ghogawala, Shekar N. Kurpad, Daniel M. Sciubba, James S. Harrop

Research output: Contribution to journalArticlepeer-review


Objective: To evaluate the use of guidelines for lumbar spine fusions among spine surgeons in North America. Methods: An anonymous survey was electronically sent to all AO Spine North America members. Survey respondents were asked to indicate their opinion surrounding the suit-ability of instrumented fusion in a variety of clinical scenarios. Fusion indications in accor-dance with North America Spine Society (NASS) guidelines for lumbar fusion were considered NASS-concordant answers. Respondents were considered to have a NASS-concordant approach if ≥ 70% (13 of 18) of their answers were NASS-concordant answers. Comparisons were performed using bivariable statistics. Results: A total of 105 responses were entered with complete data available on 70. Sixty per-cent of the respondents (n = 42) were considered compliant with NASS guidelines. NASS-dis-cordant responses did not differ between surgeons who stated that they include the NASS guidelines in their decision-making algorithm (5.10 ± 1.96) and those that did not (4.68 ± 2.09) (p = 0.395). The greatest number of NASS-discordant answers in the United States. was in the South (5.75 ± 2.09), with the lowest number in the Northeast (3.84 ± 1.70) (p < 0.01). For 5 survey items, rates of NASS-discordant answers were ≥ 40%, with the greatest number of NASS-discordant responses observed in relation to indications for fusion in spinal deformity (80%). Spine surgeons utilizing a NASS-concordant approach had a significant lower number of NASS-discordant answers for synovial cysts (p = 0.03), axial low back pain (p < 0.01), adjacent level disease (p < 0.01), recurrent stenosis (p < 0.01), recurrent disc herniation (p = 0.01), and foraminal stenosis (p < 0.01). Conclusion: This study serves an important role in clarifying the rates of uptake of clinical practice guidelines in spine surgery as well as to identify barriers to their implementation.

Original languageEnglish (US)
Pages (from-to)389-396
Number of pages8
Issue number2
StatePublished - 2021


  • AO Spine North America
  • Lumbar fusion indications
  • North America spine society

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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