Differences in the surgical treatment of recurrent lumbar disc herniation among spine surgeons in the United States

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

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Outcome measures The response data were analyzed to assess the differences among respondents over various demographic variables. The probability of disagreement is reported for various surgeon subgroups.

Methods A survey of clinical and radiographic case scenarios that included a one- and two-time lumbar disc herniation was electronically delivered to 2,560 orthopedic and neurologic surgeons in the United States. The surgical treatment options were revision microdiscectomy, revision microdiscectomy with in situ fusion, revision microdiscectomy with posterolateral fusion using pedicle screws, revision microdiscectomy with posterior lumbar interbody fusion/transforaminal lumbar interbody fusion (PLIF/TLIF), anterior lumbar interbody fusion (ALIF) with percutaneous screws, ALIF with open posterior instrumentation, or none of these. Significance of p=.01 was used to account for multiple comparisons.

Results Four hundred forty-five surgeons (18%) completed the survey. Surgeons in practice for 15+ years were more likely to select revision microdiscectomy compared with surgeons with fewer years in practice who were more likely to select revision microdiscectomy with PLIF/TLIF (p<.001). Similarly, those surgeons performing 200+ surgeries per year were more likely to select revision microdiscectomy with PLIF/TLIF than those performing fewer surgeries (p=.003). No significant differences were identified for region, specialty, fellowship training, or practice type. Overall, there was a 69% and 22% probability that two randomly selected spine surgeons would disagree on the surgical treatment of two- and one-time recurrent disc herniations, respectively. This probability of disagreement was consistent over multiple variables including geographic, practice type, fellowship training, and annual case volume.

Conclusions Significant differences exist among US spine surgeons in the surgical treatment of recurrent lumbar disc herniations. It will become increasingly important to understand the underlying reasons for these differences and to define the most cost-effective surgical strategies for these common lumbar pathologies as the United States moves closer to a value-based health-care system.

Background context There are often multiple surgical treatment options for a spinal pathology. In addition, there is a lack of data that define differences in surgical treatment among surgeons in the United States.

Purpose To assess the surgical treatment patterns among neurologic and orthopedic spine surgeons in the United States for the treatment of one- and two-time recurrent lumbar disc herniation.

Study design Electronic survey.

Patient sample An electronic survey was delivered to 2,560 orthopedic and neurologic surgeons in the United States.

Original languageEnglish
Pages (from-to)2334-2343
Number of pages10
JournalSpine Journal
Volume14
Issue number10
DOIs
StatePublished - Jan 1 2014

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Spine
Nervous System
Therapeutics
Pathology
Surgeons
Demography
Outcome Assessment (Health Care)
Surveys and Questionnaires
Delivery of Health Care
Costs and Cost Analysis
Orthopedic Surgeons

Keywords

  • Access to care
  • Cost effectiveness
  • Demographics
  • Disc herniation
  • Electronic survey
  • Geographic heterogeneity
  • Practice trends
  • Surgeon differences

Cite this

Differences in the surgical treatment of recurrent lumbar disc herniation among spine surgeons in the United States. / Mroz, Thomas E.; Lubelski, Daniel; Williams, Seth K.; O'Rourke, Colin; Obuchowski, Nancy A.; Wang, Jeffrey C.; Steinmetz, Michael P.; Melillo, Alfred J.; Benzel, Edward C.; Modic, Michael T.; Quencer, Robert.

In: Spine Journal, Vol. 14, No. 10, 01.01.2014, p. 2334-2343.

Research output: Contribution to journalArticle

Mroz, TE, Lubelski, D, Williams, SK, O'Rourke, C, Obuchowski, NA, Wang, JC, Steinmetz, MP, Melillo, AJ, Benzel, EC, Modic, MT & Quencer, R 2014, 'Differences in the surgical treatment of recurrent lumbar disc herniation among spine surgeons in the United States', Spine Journal, vol. 14, no. 10, pp. 2334-2343. https://doi.org/10.1016/j.spinee.2014.01.037
Mroz, Thomas E. ; Lubelski, Daniel ; Williams, Seth K. ; O'Rourke, Colin ; Obuchowski, Nancy A. ; Wang, Jeffrey C. ; Steinmetz, Michael P. ; Melillo, Alfred J. ; Benzel, Edward C. ; Modic, Michael T. ; Quencer, Robert. / Differences in the surgical treatment of recurrent lumbar disc herniation among spine surgeons in the United States. In: Spine Journal. 2014 ; Vol. 14, No. 10. pp. 2334-2343.
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title = "Differences in the surgical treatment of recurrent lumbar disc herniation among spine surgeons in the United States",
abstract = "Outcome measures The response data were analyzed to assess the differences among respondents over various demographic variables. The probability of disagreement is reported for various surgeon subgroups.Methods A survey of clinical and radiographic case scenarios that included a one- and two-time lumbar disc herniation was electronically delivered to 2,560 orthopedic and neurologic surgeons in the United States. The surgical treatment options were revision microdiscectomy, revision microdiscectomy with in situ fusion, revision microdiscectomy with posterolateral fusion using pedicle screws, revision microdiscectomy with posterior lumbar interbody fusion/transforaminal lumbar interbody fusion (PLIF/TLIF), anterior lumbar interbody fusion (ALIF) with percutaneous screws, ALIF with open posterior instrumentation, or none of these. Significance of p=.01 was used to account for multiple comparisons.Results Four hundred forty-five surgeons (18{\%}) completed the survey. Surgeons in practice for 15+ years were more likely to select revision microdiscectomy compared with surgeons with fewer years in practice who were more likely to select revision microdiscectomy with PLIF/TLIF (p<.001). Similarly, those surgeons performing 200+ surgeries per year were more likely to select revision microdiscectomy with PLIF/TLIF than those performing fewer surgeries (p=.003). No significant differences were identified for region, specialty, fellowship training, or practice type. Overall, there was a 69{\%} and 22{\%} probability that two randomly selected spine surgeons would disagree on the surgical treatment of two- and one-time recurrent disc herniations, respectively. This probability of disagreement was consistent over multiple variables including geographic, practice type, fellowship training, and annual case volume.Conclusions Significant differences exist among US spine surgeons in the surgical treatment of recurrent lumbar disc herniations. It will become increasingly important to understand the underlying reasons for these differences and to define the most cost-effective surgical strategies for these common lumbar pathologies as the United States moves closer to a value-based health-care system.Background context There are often multiple surgical treatment options for a spinal pathology. In addition, there is a lack of data that define differences in surgical treatment among surgeons in the United States.Purpose To assess the surgical treatment patterns among neurologic and orthopedic spine surgeons in the United States for the treatment of one- and two-time recurrent lumbar disc herniation.Study design Electronic survey.Patient sample An electronic survey was delivered to 2,560 orthopedic and neurologic surgeons in the United States.",
keywords = "Access to care, Cost effectiveness, Demographics, Disc herniation, Electronic survey, Geographic heterogeneity, Practice trends, Surgeon differences",
author = "Mroz, {Thomas E.} and Daniel Lubelski and Williams, {Seth K.} and Colin O'Rourke and Obuchowski, {Nancy A.} and Wang, {Jeffrey C.} and Steinmetz, {Michael P.} and Melillo, {Alfred J.} and Benzel, {Edward C.} and Modic, {Michael T.} and Robert Quencer",
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T1 - Differences in the surgical treatment of recurrent lumbar disc herniation among spine surgeons in the United States

AU - Mroz, Thomas E.

AU - Lubelski, Daniel

AU - Williams, Seth K.

AU - O'Rourke, Colin

AU - Obuchowski, Nancy A.

AU - Wang, Jeffrey C.

AU - Steinmetz, Michael P.

AU - Melillo, Alfred J.

AU - Benzel, Edward C.

AU - Modic, Michael T.

AU - Quencer, Robert

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Outcome measures The response data were analyzed to assess the differences among respondents over various demographic variables. The probability of disagreement is reported for various surgeon subgroups.Methods A survey of clinical and radiographic case scenarios that included a one- and two-time lumbar disc herniation was electronically delivered to 2,560 orthopedic and neurologic surgeons in the United States. The surgical treatment options were revision microdiscectomy, revision microdiscectomy with in situ fusion, revision microdiscectomy with posterolateral fusion using pedicle screws, revision microdiscectomy with posterior lumbar interbody fusion/transforaminal lumbar interbody fusion (PLIF/TLIF), anterior lumbar interbody fusion (ALIF) with percutaneous screws, ALIF with open posterior instrumentation, or none of these. Significance of p=.01 was used to account for multiple comparisons.Results Four hundred forty-five surgeons (18%) completed the survey. Surgeons in practice for 15+ years were more likely to select revision microdiscectomy compared with surgeons with fewer years in practice who were more likely to select revision microdiscectomy with PLIF/TLIF (p<.001). Similarly, those surgeons performing 200+ surgeries per year were more likely to select revision microdiscectomy with PLIF/TLIF than those performing fewer surgeries (p=.003). No significant differences were identified for region, specialty, fellowship training, or practice type. Overall, there was a 69% and 22% probability that two randomly selected spine surgeons would disagree on the surgical treatment of two- and one-time recurrent disc herniations, respectively. This probability of disagreement was consistent over multiple variables including geographic, practice type, fellowship training, and annual case volume.Conclusions Significant differences exist among US spine surgeons in the surgical treatment of recurrent lumbar disc herniations. It will become increasingly important to understand the underlying reasons for these differences and to define the most cost-effective surgical strategies for these common lumbar pathologies as the United States moves closer to a value-based health-care system.Background context There are often multiple surgical treatment options for a spinal pathology. In addition, there is a lack of data that define differences in surgical treatment among surgeons in the United States.Purpose To assess the surgical treatment patterns among neurologic and orthopedic spine surgeons in the United States for the treatment of one- and two-time recurrent lumbar disc herniation.Study design Electronic survey.Patient sample An electronic survey was delivered to 2,560 orthopedic and neurologic surgeons in the United States.

AB - Outcome measures The response data were analyzed to assess the differences among respondents over various demographic variables. The probability of disagreement is reported for various surgeon subgroups.Methods A survey of clinical and radiographic case scenarios that included a one- and two-time lumbar disc herniation was electronically delivered to 2,560 orthopedic and neurologic surgeons in the United States. The surgical treatment options were revision microdiscectomy, revision microdiscectomy with in situ fusion, revision microdiscectomy with posterolateral fusion using pedicle screws, revision microdiscectomy with posterior lumbar interbody fusion/transforaminal lumbar interbody fusion (PLIF/TLIF), anterior lumbar interbody fusion (ALIF) with percutaneous screws, ALIF with open posterior instrumentation, or none of these. Significance of p=.01 was used to account for multiple comparisons.Results Four hundred forty-five surgeons (18%) completed the survey. Surgeons in practice for 15+ years were more likely to select revision microdiscectomy compared with surgeons with fewer years in practice who were more likely to select revision microdiscectomy with PLIF/TLIF (p<.001). Similarly, those surgeons performing 200+ surgeries per year were more likely to select revision microdiscectomy with PLIF/TLIF than those performing fewer surgeries (p=.003). No significant differences were identified for region, specialty, fellowship training, or practice type. Overall, there was a 69% and 22% probability that two randomly selected spine surgeons would disagree on the surgical treatment of two- and one-time recurrent disc herniations, respectively. This probability of disagreement was consistent over multiple variables including geographic, practice type, fellowship training, and annual case volume.Conclusions Significant differences exist among US spine surgeons in the surgical treatment of recurrent lumbar disc herniations. It will become increasingly important to understand the underlying reasons for these differences and to define the most cost-effective surgical strategies for these common lumbar pathologies as the United States moves closer to a value-based health-care system.Background context There are often multiple surgical treatment options for a spinal pathology. In addition, there is a lack of data that define differences in surgical treatment among surgeons in the United States.Purpose To assess the surgical treatment patterns among neurologic and orthopedic spine surgeons in the United States for the treatment of one- and two-time recurrent lumbar disc herniation.Study design Electronic survey.Patient sample An electronic survey was delivered to 2,560 orthopedic and neurologic surgeons in the United States.

KW - Access to care

KW - Cost effectiveness

KW - Demographics

KW - Disc herniation

KW - Electronic survey

KW - Geographic heterogeneity

KW - Practice trends

KW - Surgeon differences

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