Neurospine.
2021 Jun;18(2):389-396. 10.14245/ns.2142136.068.
Are Lumbar Fusion Guidelines Followed? A Survey of North American Spine Surgeons
- Affiliations
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- 1Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
- 2Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- 3Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- 4Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, MA, USA
- 5Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- 6Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- KMID: 2517188
- DOI: http://doi.org/10.14245/ns.2142136.068
Abstract
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 suitability of instrumented fusion in a variety of clinical scenarios. Fusion indications in accordance 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 percent of the respondents (n = 42) were considered compliant with NASS guidelines. NASS-discordant 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.
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