Differences in the Surgical Treatment of Lower Back Pain Among Spine Surgeons in the United States

Daniel Lubelski, Seth K. Williams, Colin O’Rourke, Nancy A. Obuchowski, Jeffrey C. Wang, Michael P. Steinmetz, Alfred J. Melillo, Edward C C Benzel, Michael T. Modic, Robert Quencer, Thomas E. Mroz

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

STUDY DESIGN.: Electronic survey OBJECTIVE.: To identify the surgical treatment patterns for LBP, among United States spine surgeons. Specifically, determine 1) Differences in surgical treatment responses based on various demographic variables; 2) probability of disagreement based on surgeon subgroups SUMMARY OF BACKGROUND DATA.: Multiple surgical and nonsurgical treatments exist for low back pain (LBP). Without strong evidence or clear guidelines for the indications and optimal treatments, there is substantial variability in surgical treatments used. METHODS.: 445 US spine surgeons completed a survey of clinical and radiographic case scenarios on patients with mechanical LBP, no leg pain, and concordant discograms. Surgical treatment options included no surgery, anterior lumbar interbody fusion (ALIF), posterolateral fusion (PLF) with pedicle screws, transforaminal/posterior lumbar interbody fusion (TLIF/PLIF), etc. Statistical significance was set at 0.01 to account for multiple comparisons. RESULTS.: There was substantial clinical equipoise (∼75% disagreement) among surgeons on the approach to treat patients with LBP. Disagreement was highest in the southwest and lowest in the midwest (82%vs.69%, respectively); there was significantly lower disagreement among those in academic practices versus those in private/hybrid practices (56%vs.79%, respectively). Those in academic practices had ∼4 times greater odds of choosing no surgery as compared to those in hybrid and private practices, who were more likely to choose ALIF or PLIF/TLIF. Those with fellowship training had ∼2 times greater odds of selecting no surgery and 4 times greater odds of selecting ALIF as compared to those without fellowship training who were more likely to select TLIF/PLIF. CONCLUSIONS.: Significant differences exist among US spine surgeons in the treatment of LBP. These differences stem from geographical location of the practice, specialty, practice type, and fellowship training. Recognizing the substantial variability underlies the importance of additional studies aimed at identifying the proper indications and most cost effective treatments for LBP.Level of Evidence: 3

Original languageEnglish (US)
JournalSpine
DOIs
StateAccepted/In press - Dec 14 2015

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Low Back Pain
Spine
Private Practice
Therapeutics
Surgeons
Health Care Costs
Leg
Demography
Guidelines
Pain

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Lubelski, D., Williams, S. K., O’Rourke, C., Obuchowski, N. A., Wang, J. C., Steinmetz, M. P., ... Mroz, T. E. (Accepted/In press). Differences in the Surgical Treatment of Lower Back Pain Among Spine Surgeons in the United States. Spine. https://doi.org/10.1097/BRS.0000000000001396

Differences in the Surgical Treatment of Lower Back Pain Among Spine Surgeons in the United States. / Lubelski, Daniel; Williams, Seth K.; O’Rourke, Colin; Obuchowski, Nancy A.; Wang, Jeffrey C.; Steinmetz, Michael P.; Melillo, Alfred J.; Benzel, Edward C C; Modic, Michael T.; Quencer, Robert; Mroz, Thomas E.

In: Spine, 14.12.2015.

Research output: Contribution to journalArticle

Lubelski, D, Williams, SK, O’Rourke, C, Obuchowski, NA, Wang, JC, Steinmetz, MP, Melillo, AJ, Benzel, ECC, Modic, MT, Quencer, R & Mroz, TE 2015, 'Differences in the Surgical Treatment of Lower Back Pain Among Spine Surgeons in the United States', Spine. https://doi.org/10.1097/BRS.0000000000001396
Lubelski D, Williams SK, O’Rourke C, Obuchowski NA, Wang JC, Steinmetz MP et al. Differences in the Surgical Treatment of Lower Back Pain Among Spine Surgeons in the United States. Spine. 2015 Dec 14. https://doi.org/10.1097/BRS.0000000000001396
Lubelski, Daniel ; Williams, Seth K. ; O’Rourke, Colin ; Obuchowski, Nancy A. ; Wang, Jeffrey C. ; Steinmetz, Michael P. ; Melillo, Alfred J. ; Benzel, Edward C C ; Modic, Michael T. ; Quencer, Robert ; Mroz, Thomas E. / Differences in the Surgical Treatment of Lower Back Pain Among Spine Surgeons in the United States. In: Spine. 2015.
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abstract = "STUDY DESIGN.: Electronic survey OBJECTIVE.: To identify the surgical treatment patterns for LBP, among United States spine surgeons. Specifically, determine 1) Differences in surgical treatment responses based on various demographic variables; 2) probability of disagreement based on surgeon subgroups SUMMARY OF BACKGROUND DATA.: Multiple surgical and nonsurgical treatments exist for low back pain (LBP). Without strong evidence or clear guidelines for the indications and optimal treatments, there is substantial variability in surgical treatments used. METHODS.: 445 US spine surgeons completed a survey of clinical and radiographic case scenarios on patients with mechanical LBP, no leg pain, and concordant discograms. Surgical treatment options included no surgery, anterior lumbar interbody fusion (ALIF), posterolateral fusion (PLF) with pedicle screws, transforaminal/posterior lumbar interbody fusion (TLIF/PLIF), etc. Statistical significance was set at 0.01 to account for multiple comparisons. RESULTS.: There was substantial clinical equipoise (∼75{\%} disagreement) among surgeons on the approach to treat patients with LBP. Disagreement was highest in the southwest and lowest in the midwest (82{\%}vs.69{\%}, respectively); there was significantly lower disagreement among those in academic practices versus those in private/hybrid practices (56{\%}vs.79{\%}, respectively). Those in academic practices had ∼4 times greater odds of choosing no surgery as compared to those in hybrid and private practices, who were more likely to choose ALIF or PLIF/TLIF. Those with fellowship training had ∼2 times greater odds of selecting no surgery and 4 times greater odds of selecting ALIF as compared to those without fellowship training who were more likely to select TLIF/PLIF. CONCLUSIONS.: Significant differences exist among US spine surgeons in the treatment of LBP. These differences stem from geographical location of the practice, specialty, practice type, and fellowship training. Recognizing the substantial variability underlies the importance of additional studies aimed at identifying the proper indications and most cost effective treatments for LBP.Level of Evidence: 3",
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AU - Obuchowski, Nancy A.

AU - Wang, Jeffrey C.

AU - Steinmetz, Michael P.

AU - Melillo, Alfred J.

AU - Benzel, Edward C C

AU - Modic, Michael T.

AU - Quencer, Robert

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