Association of decision-making in spinal surgery with specialty and emotional involvement—the Indications in Spinal Surgery (INDIANA) survey
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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.
KeywordsDecision-making Degenerative spinal disorders Emotional involvement Lumbar disk herniation Lumbar degenerative spondylolisthesis Lumbar spinal stenosis
American Medical Association
body mass index
british medical research council
lumbar disk herniation
Indications in Spinal Surgery
magnetic resonance imaging
randomized controlled trial
lumbar degenerative spondylolisthesis
Spine Patient Outcomes Research Trial
lumbar spinal stenosis
visual analogue scale
NS gratefully acknowledges the support of the Graduate School’s Faculty Graduate Center of Medicine of our university.
The study was financed by institutional grants from the Department of Neurosurgery.
Compliance with ethical standards
Conflict of interest
SK is consultant for Brainlab AG (Munich, Germany) and Nexstim Plc (Helsinki, Finland). The authors declare that they have no conflict of interest regarding the methods used or results presented in this survey.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all participants who took part in this survey.
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