Abdelnour Mark, Mumtaz Rohail, Hawsawi Mamdoh Al, Qumqumji Feras, Swamy Ganesh, Thomas Kenneth, Soroceanu Alex, Wang Zhi, Stratton Alexandra, Kingwell Stephen P, Wai Eugene, Tsai Eve, Phan Philippe
Faculty of Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, ON, Canada.
Division of Orthopaedics, The Ottawa Hospital - Civic Campus, 1053 Carling Ave, Ottawa, Ontario, Canada.
Spine J. 2025 Jan 17. doi: 10.1016/j.spinee.2025.01.003.
Significant variability in the management of Adult Spinal Deformity (ASD) has been observed among spine surgeons worldwide. The variability among Canadian spine surgeons, a country with universal public healthcare, remains unknown.
The study aims to evaluate areas of variability in the perioperative optimization and surgical management of ASD among Canadian spine surgeons.
STUDY DESIGN/SETTING: In this cross-sectional study, 25 Canadian spine surgeons, predominantly orthopedic surgeons (20) and neurosurgeons (5) with varying experience, participated in an online survey focused on Adult Spinal Deformity (ASD).
The study involved 25 Canadian spine surgeons with varying level of experience, representing both orthopedic and neurosurgical specialities.
The study aimed to evaluate the variability in surgical decision-making and perioperative optimization strategies among Canadian spine surgeons when faced with simulated scenarios of ASD pathologies.
The online survey presented 4 vignettes with simulated scenarios of the most common ASD pathologies, including High Grade Spondylolisthesis (HGS), Neglected Adolescent Idiopathic Scoliosis (NAIS), Degenerative Scoliosis (DS), and Flat Back Syndrome (FBS). Questions in the vignettes explored ASD surgical decision-making, while additional questions focused on perioperative optimization. Descriptive statistics were used to analyze multiple-choice responses, and open-text responses were categorized into themes.
Variability was observed in the duration conservative treatment across the 4 ASD cases. Surgeons exhibited variability in the use of preoperative osteoporosis treatment. There was varied use of a dedicated anesthesiology team. Surgical goals varied in HGS and NAIS. The primary surgical method was variable in DS and HGS, the type of osteotomy varied in DS and FBS, and level of fixation varied in HGS and NAIS. Consensus was observed in the use of intraoperative monitoring across of all 4 ASD pathologies, the implementation of a team-based approach, and the selection of the primary surgical goal in DS and FBS.
Our cross-sectional study revealed variability among Canadian spine surgeons in the management of ASD, potentially influenced by the uncertain ASD progression, the need for evidence-based nonsurgical guidelines, and insufficient evidence on optimal surgical approaches. These findings will help guide future research to ultimately reduce variability and improve ASD patient management and outcomes.
全球脊柱外科医生在成人脊柱畸形（ASD）的治疗管理方面存在显著差异。在拥有全民公共医疗保健体系的加拿大，脊柱外科医生之间的差异情况尚不清楚。
本研究旨在评估加拿大脊柱外科医生在ASD围手术期优化及手术管理方面的差异领域。
研究设计/地点：在这项横断面研究中，25名加拿大脊柱外科医生参与了一项针对成人脊柱畸形（ASD）的在线调查，这些医生主要是骨科医生（20名）和神经外科医生（5名），经验各异。
该研究涉及25名经验水平不同的加拿大脊柱外科医生，涵盖骨科和神经外科两个专业领域。
本研究旨在评估加拿大脊柱外科医生在面对模拟的ASD病理情况时，手术决策和围手术期优化策略方面的差异。
在线调查展示了4个带有最常见ASD病理模拟场景的案例，包括重度椎体滑脱（HGS）、青少年特发性脊柱侧弯失治（NAIS）、退变性脊柱侧弯（DS）和平背综合征（FBS）。案例中的问题探讨了ASD手术决策，其他问题则聚焦于围手术期优化。描述性统计用于分析多项选择题的答案，开放性文本答案被归类为不同主题。
在4种ASD病例中，保守治疗的时长存在差异。外科医生在术前骨质疏松治疗的使用上存在差异；在是否使用专门的麻醉团队方面也各有不同。HGS和NAIS的手术目标存在差异；DS和HGS的主要手术方法不同，DS和FBS的截骨类型不同，HGS和NAIS的固定节段不同。在所有4种ASD病理情况下术中监测的使用、基于团队方法的实施以及DS和FBS主要手术目标的选择上达成了共识。
我们的横断面研究揭示了加拿大脊柱外科医生在ASD治疗管理方面存在差异，这可能受到ASD进展不确定、缺乏基于证据的非手术指南以及最佳手术方法证据不足的影响。这些发现将有助于指导未来的研究，最终减少差异，改善ASD患者的管理和治疗效果。
