Lewandrowski Kai-Uwe, Alvim Fiorelli Rossano Kepler, Pereira Mauricio G, Abraham Ivo, Alfaro Pachicano Heber Humberto, Elfar John C, Alhammoud Abduljabbar, Landgraeber Stefan, Oertel Joachim, Hellinger Stefan, Dowling Álvaro, De Carvalho Paulo Sérgio Teixeira, Ramos Max R F, Defino Helton, Bergamaschi João Paulo, Montemurro Nicola, Yeung Christopher, Brito Marcelo, Beall Douglas P, Ivanic Gerd, Xifeng Zhang, Li Zhen-Zhou, Kim Jin-Sung L, Ramirez Jorge F, Lorio Morgan P
Division Personalized Pain Research and Education, Center for Advanced Spine Care of Southern Arizona, Tucson, Arizona, USA
Department of Orthopaedics, Full Professor of Orthopedic Surgery, Fundación Universitaria Sanitas, Bogotá, D.C., Colombia.
Int J Spine Surg. 2024 May 6;18(2):164-177. doi: 10.14444/8595.
With the growing prevalence of lumbar spinal stenosis, endoscopic surgery, which incorporates techniques such as transforaminal, interlaminar, and unilateral biportal (UBE) endoscopy, is increasingly considered. However, the patient selection criteria are debated among spine surgeons.
This study used a polytomous Rasch analysis to evaluate the factors influencing surgeon decision-making in selecting patients for endoscopic surgical treatment of lumbar spinal stenosis.
A comprehensive survey was distributed to a representative sample of 296 spine surgeons. Questions encompassed various patient-related and clinical factors, and responses were captured on a logit scale graphically displaying person-item maps and category probability curves for each test item. Using a Rasch analysis, the data were subsequently analyzed to determine the latent traits influencing decision-making.
The Rasch analysis revealed that surgeons' preferences for transforaminal, interlaminar, and UBE techniques were easily influenced by comfort level and experience with the endoscopic procedure and patient-related factors. Harder-to-agree items included technological aspects, favorable clinical outcomes, and postoperative functional recovery and rehabilitation. Descriptive statistics suggested interlaminar as the best endoscopic spinal stenosis decompression technique. However, logit person-item analysis integral to the Rasch methodology showed highest intensity for transforaminal followed by interlaminar endoscopic lumbar stenosis decompression. The UBE technique was the hardest to agree on with a disordered person-item analysis and thresholds in category probability curve plots.
Surgeon decision-making in selecting patients for endoscopic surgery for lumbar spinal stenosis is multifaceted. While the framework of clinical guidelines remains paramount, on-the-ground experience-based factors significantly influence surgeons' selection of patients for endoscopic lumbar spinal stenosis surgeries. The Rasch methodology allows for a more granular psychometric evaluation of surgeon decision-making and accounts better for years-long experience that may be lost in standardized clinical guideline development. This new approach to assessing spine surgeons' thought processes may improve the implementation of evidence-based protocol change dictated by technological advances was endorsed by the Interamerican Society for Minimally Invasive Spine Surgery (SICCMI), the International Society for Minimal Intervention in Spinal Surgery (ISMISS), the Mexican Spine Society (AMCICO), the Brazilian Spine Society (SBC), the Society for Minimally Invasive Spine Surgery (SMISS), the Korean Minimally Invasive Spine Society (KOMISS), and the International Society for the Advancement of Spine Surgery (ISASS).
随着腰椎管狭窄症患病率的不断上升，包括经椎间孔、椎板间和单侧双通道（UBE）内镜等技术的内镜手术越来越受到关注。然而，脊柱外科医生对于患者选择标准存在争议。
本研究采用多分类Rasch分析来评估影响脊柱外科医生选择腰椎管狭窄症患者进行内镜手术治疗决策的因素。
向296名脊柱外科医生的代表性样本发放了一份综合调查问卷。问题涵盖了各种与患者相关的和临床因素，并以对数尺度记录回答，以图形方式展示每个测试项目的人-项目图和类别概率曲线。随后使用Rasch分析对数据进行分析，以确定影响决策的潜在特征。
Rasch分析显示，外科医生对经椎间孔、椎板间和UBE技术的偏好很容易受到内镜手术舒适度和经验以及患者相关因素的影响。较难达成共识的项目包括技术方面、良好的临床结果以及术后功能恢复和康复。描述性统计表明椎板间是最佳的内镜下腰椎管狭窄减压技术。然而，Rasch方法中不可或缺的对数人-项目分析显示，经椎间孔内镜下腰椎管狭窄减压的强度最高，其次是椎板间内镜下腰椎管狭窄减压。UBE技术在人-项目分析和类别概率曲线图中的阈值方面最难达成共识。
脊柱外科医生在选择腰椎管狭窄症患者进行内镜手术时的决策是多方面的。虽然临床指南的框架仍然至关重要，但基于实际经验的因素会显著影响外科医生对腰椎管狭窄症内镜手术患者的选择。Rasch方法能够对外科医生的决策进行更细致的心理测量评估，并且能更好地考虑到在标准化临床指南制定过程中可能被忽视的多年经验。这种评估脊柱外科医生思维过程的新方法可能会改善由技术进步所推动的循证方案变革的实施，得到了美洲微创脊柱外科学会（SICCMI）、国际脊柱微创干预学会（ISMISS）、墨西哥脊柱学会（AMCICO）、巴西脊柱学会（SBC）、微创脊柱外科学会（SMISS）、韩国微创脊柱学会（KOMISS）和国际脊柱外科学会（ISASS）的认可。
