Clinique des Cèdres, Neurosurgery, Toulouse, France.
Department of Orthopedic Surgery, Hôpital Raymond Poincaré, Garches, France.
Spine (Phila Pa 1976). 2018 Feb 1;43(3):185-192. doi: 10.1097/BRS.0000000000002272.
Electronic survey.
The aim of this study was to identify the international nuances in surgical treatment patterns for severals lumbar degenerative conditions, specifically, to identify differences in responses in each country groupand different treatment trends across countries.
Significant variations in treatment of lumbar degenerative conditions exist among spine surgeons, related to the lack of established consensus in the literature.
An online survey with preformulated answers was submitted to 52 orthopedic surgeons, 50 neurosurgeons from four different countries (United States, France, Spain, and Germany) regarding five vignette-cases. Cases included: multilevel stenosis, monolevel stenosis, lytic spondylolisthesis, isthmic lysis, and degenerative scoliosis. The variability for each country was calculated according to the Index of Qualitative Variation (IQV = 0: no variability and 1: maximal variability). We used Fleiss kappa (range: from -1, poor agreement, to 1, almost perfect agreement) for assessing the reliability of agreement between the participants concerning specialties, countries, and age groups.
For the two stenosis cases, US surgeons were more likely to propose decompression (IQV multilevel = 0.47 and monolevel = 0.32) comparing with European countries more heterogeneous (all IQV >0.70) and more frequently proposing fusion. As regards degenerative scoliosis, all attitudes were extremely heterogeneous with IQV >0.8. Fusion for isthmic spondylolisthesis was more consensual (all IQV <0.63), but attitudes were more heterogeneous for isthmic lysis (IQV ranged from 0.48 to 0.76) with anterior approach proposed in France (37%) and United States (19.2%).The overall interrater agreement was equally slight not only for neurosurgeons (Fleiss Kappa = 0.04) and orthopedic surgeons (Kappa = 0.13), but also for countries (Kappa <0.13) and age groups (Kappa <0.1).
In this study, we found substantial agreement for some spinal conditions but a high variability in some others: intranational and international variations were observed, reflecting the lack of literature consensus.
电子调查。
本研究旨在确定几种腰椎退行性疾病的国际手术治疗模式的细微差别，具体来说，确定每个国家组的反应差异以及国家之间的不同治疗趋势。
由于文献中缺乏既定共识，脊柱外科医生在治疗腰椎退行性疾病方面存在显著差异。
向来自四个国家（美国、法国、西班牙和德国）的 52 名骨科医生和 50 名神经外科医生提交了一份带有预设答案的在线调查，内容涉及五个案例。案例包括：多节段狭窄、单节段狭窄、溶骨性脊椎滑脱、峡部裂和退行性脊柱侧凸。根据定性变异指数（IQV=0：无变异，1：最大变异）计算每个国家的变异性。我们使用 Fleiss kappa（范围：从-1，差的一致性，到 1，几乎完美的一致性）评估参与者对专业、国家和年龄组的一致性的可靠性。
对于两种狭窄病例，美国外科医生更倾向于提出减压（多节段 IQV=0.47 和单节段 IQV=0.32），而欧洲国家的态度更加多样化（所有 IQV>0.70），更频繁地提出融合。至于退行性脊柱侧凸，所有的态度都非常多样化，IQV>0.8。峡部脊椎滑脱的融合更为一致（所有 IQV<0.63），但峡部裂的态度更为多样化（IQV 从 0.48 到 0.76），法国（37%）和美国（19.2%）提出了前路方法。神经外科医生（Fleiss Kappa=0.04）和骨科医生（Kappa=0.13）、国家（Kappa<0.13）和年龄组（Kappa<0.1）的总体评分者间一致性同样微弱。
在这项研究中，我们发现一些脊柱疾病的一致性较高，但其他一些疾病的变异性较大：观察到国内和国际的差异，反映了文献共识的缺乏。
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