Sollmann Nico, Morandell Carmen, Albers Lucia, Behr Michael, Preuss Alexander, Dinkel Andreas, Meyer Bernhard, Krieg Sandro M
Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Acta Neurochir (Wien). 2018 Mar;160(3):425-438. doi: 10.1007/s00701-017-3459-7. Epub 2018 Jan 10.
Although recent trials provided level I evidence for the most common degenerative lumbar spinal disorders, treatment still varies widely. Thus, the Indications in Spinal Surgery (INDIANA) survey explores whether decision-making is influenced by specialty or personal emotional involvement of the treating specialist.
Nationwide, neurosurgeons and orthopedic surgeons specialized in spine surgery were asked to answer an Internet-based questionnaire with typical clinical patient cases of lumbar disc herniation (DH), lumbar spinal stenosis (SS), and lumbar degenerative spondylolisthesis (SL). The surgeons were assigned to counsel a patient or a close relative, thus creating emotional involvement. This was achieved by randomly allocating the surgeons to a patient group (PG) and relative group (RG). We then compared neurosurgeons to orthopedic surgeons and the PG to the RG regarding treatment decision-making.
One hundred twenty-two spine surgeons completed the questionnaire (response rate 78.7%). Regarding DH and SS, more conservative treatment among orthopedic surgeons was shown (DH: odds ratio [OR] 4.1, 95% confidence interval [CI] 1.7-9.7, p = 0.001; SS: OR 3.9, CI 1.8-8.2, p < 0.001). However, emotional involvement (PG vs. RG) did not affect these results for any of the three cases (DH: p = 0.213; SS: p = 0.097; SL: p = 0.924).
The high response rate indicates how important the issues raised by this study actually are for dedicated spine surgeons. Moreover, there are considerable variations in decision-making for the most common degenerative lumbar spinal disorders, although there is high-quality data from large multicenter trials available. Emotional involvement, though, did not influence treatment recommendations.
尽管近期的试验为最常见的退行性腰椎疾病提供了一级证据，但治疗方法仍存在很大差异。因此，脊柱外科手术适应症（INDIANA）调查探讨了决策是否受到治疗专家的专业领域或个人情感因素的影响。
在全国范围内，邀请专门从事脊柱外科手术的神经外科医生和骨科医生回答一份基于互联网的问卷，问卷包含腰椎间盘突出症（DH）、腰椎管狭窄症（SS）和腰椎退行性滑脱症（SL）的典型临床患者病例。外科医生被分配去为患者或其近亲提供咨询，从而产生情感因素。这是通过将外科医生随机分配到患者组（PG）和亲属组（RG）来实现的。然后，我们比较了神经外科医生和骨科医生以及PG组和RG组在治疗决策方面的差异。
122名脊柱外科医生完成了问卷（回复率78.7%）。对于DH和SS，骨科医生更倾向于采用保守治疗（DH：优势比[OR]4.1，95%置信区间[CI]1.7 - 9.7，p = 0.001；SS：OR 3.9，CI 1.8 - 8.2，p < 0.001）。然而，情感因素（PG组与RG组）对这三种病例中的任何一种结果均无影响（DH：p = 0.213；SS：p = 0.097；SL：p = 0.924）。
高回复率表明本研究提出的问题对于专注的脊柱外科医生来说实际上有多重要。此外，尽管有来自大型多中心试验的高质量数据，但对于最常见的退行性腰椎疾病，决策仍存在相当大的差异。不过，情感因素并未影响治疗建议。
