Are Minimally Invasive Spine Surgeons or Classical Open Spine Surgeons More Consistent with Their Treatment of Adult Spinal Deformity?

dc.contributor.author

Uribe, Juan S

dc.contributor.author

Koffie, Robert M

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Wang, Michael Y

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Mundis, Gregory M

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Kanter, Adam S

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Eastlack, Robert K

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Anand, Neel

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Park, Paul

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Smith, Justin S

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Burton, Douglas C

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Chou, Dean

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Kelly, Michael P

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Kim, Han Jo

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Bess, Shay

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Shaffrey, Christopher I

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Schwab, Frank J

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Lenke, Lawrence G

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Mummaneni, Praveen V

dc.date.accessioned

2023-06-16T15:24:30Z

dc.date.available

2023-06-16T15:24:30Z

dc.date.issued

2022-09

dc.date.updated

2023-06-16T15:24:30Z

dc.description.abstract

Objective

Spine surgeons have a heuristic sense of how to surgically restore alignment and address adult spinal deformity (ASD) symptoms, but consensus on the extent of treatment remains unclear. We sought to determine the variability of surgical approaches in treating ASD.

Methods

Sixteen spine surgeons were surveyed on treatment approaches in 10 select ASD cases. We repeated the survey with the same surgeons 4 weeks later, with cases ordered differently. We examined the variability in length of construct, use of interbody spacers, osteotomies, and pelvic fixation frequency.

Results

Treatment approaches for each case varied by surgeon, with some surgeons opting for long fusion constructs in cases for which others offered no surgery. There was no consensus among surgeons on the number of levels fused, interbody spacer use, or anterior/posterior osteotomies. Intersurgeon and intrasurgeon variability was 48% (kappa = 0.31) and 59% (kappa = 0.44) for surgeons performing minimally invasive surgery (MIS) versus 37% (kappa = 0.21) and 47% (kappa = 0.30) for those performing open surgery. In the second-round survey, 8 of 15 (53%) surgeons substantially changed the construct length, number of interbody spacers, and osteotomies in at least half the cases they previously reviewed. Surgeons performing MIS versus open surgery were less likely to extend constructs to the pelvis (42.5% vs. 67.5%; P = 0.02), but construct length was not correlated with whether a surgeon performed MIS or open surgery.

Conclusions

Spinal deformity surgeons lack consensus on the optimal surgical approach for treating ASD. Classifying surgeons as performing MIS or open surgery does not mitigate this variability.
dc.identifier

S1878-8750(22)00717-3

dc.identifier.issn

1878-8750

dc.identifier.issn

1878-8769

dc.identifier.uri

https://hdl.handle.net/10161/28055

dc.language

eng

dc.publisher

Elsevier BV

dc.relation.ispartof

World neurosurgery

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10.1016/j.wneu.2022.05.078

dc.subject

Spine

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Lumbar Vertebrae

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Humans

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Spinal Dysraphism

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Treatment Outcome

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Spinal Fusion

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Retrospective Studies

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Adult

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Minimally Invasive Surgical Procedures

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Surgeons

dc.title

Are Minimally Invasive Spine Surgeons or Classical Open Spine Surgeons More Consistent with Their Treatment of Adult Spinal Deformity?

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.begin-page

e51

pubs.end-page

e58

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

Published

pubs.volume

165

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