Camino-Willhuber Gaston, Bigdon Sebastian, Dandurand Charlotte, Dvorak Marcel F, Öner Cumhur F, Schnake Klaus, Muijs Sander, Benneker Lorin M, Vialle Emiliano, Tee Jin W, Keynan Ory, Chhabra Harvinder S, Joaquim Andrei F, Popescu Eugen C, Canseco Jose A, Holas Martin, Kanna Rishi M, Aly Mohamed M, Fallah Nader, Schroeder Gregory D, Spiegl Ulrich, El-Skarkawi Mohammad, Bransford Richard J, Rajasekaran Shanmuganathan, Vaccaro Alexander R
Institute of Orthopedics "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Bern, Switzerland.
Global Spine J. 2024 Feb;14(1_suppl):49S-55S. doi: 10.1177/21925682231194456.
Retrospective analysis of prospectively collected data.
To compare decision-making between an expert panel and real-world spine surgeons in thoracolumbar burst fractures (TLBFs) without neurological deficits and analyze which factors influence surgical decision-making.
This study is a sub-analysis of a prospective observational study in TL fractures. Twenty two experts were asked to review 183 CT scans and recommend treatment for each fracture. The expert recommendation was based on radiographic review.
Overall agreement between the expert panel and real-world surgeons regarding surgery was 63.2%. In 36.8% of cases, the expert panel recommended surgery that was not performed in real-world scenarios. Conversely, in cases where the expert panel recommended non-surgical treatment, only 38.6% received non-surgical treatment, while 61.4% underwent surgery. A separate analysis of A3 and A4 fractures revealed that expert panel recommended surgery for 30% of A3 injuries and 68% of A4 injuries. However, 61% of patients with both A3 and A4 fractures received surgery in the real world. Multivariate analysis demonstrated that a 1% increase in certainty of PLC injury led to a 4% increase in surgery recommendation among the expert panel, while a .2% increase in the likelihood of receiving surgery in the real world.
Surgical decision-making varied between the expert panel and real-world treating surgeons. Differences appear to be less evident in A3/A4 burst fractures making this specific group of fractures a real challenge independent of the level of expertise.
对前瞻性收集的数据进行回顾性分析。
比较专家小组与实际脊柱外科医生在无神经功能缺损的胸腰椎爆裂骨折（TLBFs）中的决策情况，并分析哪些因素影响手术决策。
本研究是对TL骨折前瞻性观察研究的子分析。邀请22位专家对183份CT扫描进行评估，并对每例骨折推荐治疗方案。专家的推荐基于影像学评估。
专家小组与实际脊柱外科医生在手术决策上的总体一致性为63.2%。在36.8%的病例中，专家小组推荐的手术在实际情况中未实施。相反，在专家小组推荐非手术治疗的病例中，只有38.6%接受了非手术治疗，而61.4%接受了手术。对A3和A4骨折的单独分析显示，专家小组对30%的A3损伤和68%的A4损伤推荐手术。然而，在现实中，A3和A4骨折患者中有61%接受了手术。多变量分析表明，PLC损伤确定性每增加1%，专家小组推荐手术的概率增加4%，而在现实中接受手术的可能性增加0.2%。
专家小组与实际治疗的外科医生之间的手术决策存在差异。在A3/A4爆裂骨折中，差异似乎不太明显，这使得这一特定骨折组成为一个独立于专业水平的真正挑战。
