TY - JOUR
T1 - Are lumbar fusion guidelines followed? A survey of north American spine surgeons
AU - Montenegro, Thiago S.
AU - Elia, Christopher
AU - Hines, Kevin
AU - Buser, Zorica
AU - Wilson, Jefferson
AU - Ghogawala, Zoher
AU - Kurpad, Shekar N.
AU - Sciubba, Daniel M.
AU - Harrop, James S.
N1 - Publisher Copyright:
© 2021 by the Korean Spinal Neurosurgery Society.
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
KW - AO Spine North America
KW - Lumbar fusion indications
KW - North America spine society
UR - http://www.scopus.com/inward/record.url?scp=85109377667&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85109377667&partnerID=8YFLogxK
U2 - 10.14245/ns.2142136.068
DO - 10.14245/ns.2142136.068
M3 - Article
C2 - 34218620
AN - SCOPUS:85109377667
SN - 2586-6583
VL - 18
SP - 389
EP - 396
JO - Neurospine
JF - Neurospine
IS - 2
ER -