Lewandrowski Kai-Uwe, Soriano-Sánchez José-Antonio, Zhang Xifeng, Ramírez León Jorge Felipe, Soriano Solis Sergio, Rugeles Ortíz José Gabriel, Martínez Carolina Ramírez, Alonso Cuéllar Gabriel Oswaldo, Liu Kaixuan, Fu Qiang, de Lima E Silva Marlon Sudário, de Carvalho Paulo Sérgio Teixeira, Hellinger Stefan, Dowling Álvaro, Prada Nicholas, Choi Gun, Datar Girish, Yeung Anthony
Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson, AZ, USA.
Department Neurosurgery, UNIRIO, Rio de Janeiro, Brazil.
J Spine Surg. 2020 Jan;6(Suppl 1):S249-S259. doi: 10.21037/jss.2019.08.02.
This study aimed to analyze the motivators and obstacles to the implementation of minimally invasive spinal surgery techniques (MISST) by spinal surgeons. Motivators and detractors may impact the availability of MISST to patients and drive spine surgeons' clinical decision-making in the treatment of common degenerative conditions of the lumbar spine.
The authors solicited responses to an online survey sent to spine surgeons by email, and chat groups in social media networks including Facebook, WeChat, WhatsApp, and Linkedin. Descriptive statistics were employed to count the responses and compared to the surgeon's training. Kappa statistics and linear regression analysis of agreement were performed.
A total of 430 surgeons accessed the survey. The completion rate was 67.4%. A total of 292 surveys were submitted by 99 neurosurgeons (33.9%), 170 orthopaedic surgeons (58.2%), and 23 surgeons of other postgraduate training (7.9%). Personal interest (82.5%) and patient demand (48.6%) were the primary motivators for MISST implementation. High equipment (48.3%) and disposables (29.1%) cost were relevant obstacles to MISST implementation. Local workshops (47.6%) and meetings in small groups (31.8%) were listed as the primary knowledge sources. Only 12% of surgeons were fellowship trained, but 46.3% of surgeons employed MISST in over 25% of their cases.
The rate of implementation of MISST reported by spine surgeons was found to be high but impeded by the high cost of equipment and disposables. The primary motivators for spine surgeons' desire to implement were personal interest and patient demand.
本研究旨在分析脊柱外科医生实施微创脊柱手术技术（MISST）的动机和障碍。推动因素和阻碍因素可能会影响患者获得MISST的机会，并驱动脊柱外科医生在治疗腰椎常见退行性疾病时的临床决策。
作者通过电子邮件向脊柱外科医生发送在线调查问卷，并在包括Facebook、微信、WhatsApp和领英在内的社交媒体网络聊天群组中征集回复。采用描述性统计方法对回复进行计数，并与外科医生的培训情况进行比较。进行了kappa统计和一致性线性回归分析。
共有430名外科医生访问了该调查。完成率为67.4%。共有292份调查问卷由99名神经外科医生（33.9%）、170名骨科医生（58.2%）和23名其他研究生培训的外科医生（7.9%）提交。个人兴趣（82.5%）和患者需求（48.6%）是实施MISST的主要动机。设备成本高（48.3%）和一次性用品成本高（29.1%）是实施MISST的相关障碍。当地研讨会（47.6%）和小组会议（31.8%）被列为主要知识来源。只有12%的外科医生接受过专项培训，但46.3%的外科医生在超过25%的病例中采用了MISST。
脊柱外科医生报告的MISST实施率较高，但受到设备和一次性用品高成本的阻碍。脊柱外科医生实施MISST的主要动机是个人兴趣和患者需求。
