Variability in Surgical Therapy of Spondylolisthesis amongst Backbone Surgeons.
World Neurosurg. 2017 Dec 27;:
Authors: Lubelski D, Alentado V, Williams S, O’Rourke C, Obuchowski N, Wang JC, Steinmetz M, Melillo A, Benzel E, Modic M, Quencer R, Mroz T
BACKGROUND: There are a large number of remedies for low grade lumbar spondylolisthesis. There are not any clear pointers for the optimum strategy.
OBJECTIVE: To determine the surgical remedy patterns for spondylolisthesis, amongst United States backbone surgeons METHODS: 445 US backbone surgeons accomplished a survey of medical/radiographic case eventualities on sufferers with lumbar spondylolisthesis with neurogenic claudication with (S+BP) or with out (S-BP) related mechanical again ache. Therapy choices included decompression, laminectomy with posterolateral fusion, posterior lumbar interbody fusion, or not one of the above. The first end result measure was the chance of two randomly chosen surgeons disagreeing on the remedy methodology.
RESULTS: There was 64% disagreement (36% settlement) amongst surgeons for remedy of spondylolisthesis with mechanical again ache (S+BP) and 71% disagreement (29% settlement) for spondylolisthesis with out mechanical again ache (S-BP). For S+BP, disagreement was 52% for these training 5-10 years versus 70% amongst these training >20 years. Orthopedic surgeons had larger disagreement in comparison with neurosurgeons (76% vs 56%) for S+BP. Better medical equipoise was seen for S-BP in comparison with S+BP no matter surgeon traits. For spondylolisthesis with out mechanical again ache, neurosurgeons had been considerably extra prone to choose decompression-only as in comparison with orthopedic surgeons who extra generally fused.
CONCLUSIONS: Scientific equipoise exists for the remedy of spondylolisthesis. Variations are larger when the affected person presents with out related again ache. Surgeon case quantity, apply length, and specialty coaching affect operative choices for a given pathology. Recognizing this apply variation will hopefully result in higher proof and apply pointers for the optimum and most price efficient remedy paradigms.
PMID: 29288862 [PubMed – as supplied by publisher]