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Acta Neurochirurgica

, Volume 160, Issue 3, pp 425–438 | Cite as

Association of decision-making in spinal surgery with specialty and emotional involvement—the Indications in Spinal Surgery (INDIANA) survey

  • Nico Sollmann
  • Carmen Morandell
  • Lucia Albers
  • Michael Behr
  • Alexander Preuss
  • Andreas Dinkel
  • Bernhard Meyer
  • Sandro M. Krieg
Original - Spine

Abstract

Background

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.

Method

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.

Results

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).

Conclusions

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.

Keywords

Decision-making Degenerative spinal disorders Emotional involvement Lumbar disk herniation Lumbar degenerative spondylolisthesis Lumbar spinal stenosis 

Abbreviations

AMA

American Medical Association

BMI

body mass index

BMRC

british medical research council

CI

confidence interval

DH

lumbar disk herniation

INDIANA

Indications in Spinal Surgery

MRI

magnetic resonance imaging

OR

odds ratio

PG

patient group

RCT

randomized controlled trial

RG

relative group

SL

lumbar degenerative spondylolisthesis

SPORT

Spine Patient Outcomes Research Trial

SD

standard deviation

SS

lumbar spinal stenosis

VAS

visual analogue scale

Notes

Acknowledgements

NS gratefully acknowledges the support of the Graduate School’s Faculty Graduate Center of Medicine of our university.

Funding

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.

Ethical approval

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

Informed consent was obtained from all participants who took part in this survey.

References

  1. 1.
    American Medical Association Council on Ethical and Judicial Affairs Chapter 1: Opinions on Patient-Physician Relationships. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page. Accessed 14 Sept 2016
  2. 2.
    Arnold PM, Brodke DS, Rampersaud YR, Harrop JS, Dailey AT, Shaffrey CI, Grauer JN, Dvorak MF, Bono CM, Wilsey JT, Lee JY, Nassr A, Vaccaro AR, Spine Trauma Study G (2009) Differences between neurosurgeons and orthopedic surgeons in classifying cervical dislocation injuries and making assessment and treatment decisions: a multicenter reliability study. Am J Orthop 38:E156–E161PubMedGoogle Scholar
  3. 3.
    Atlas SJ, Keller RB, Chang Y, Deyo RA, Singer DE (2001) Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: five-year outcomes from the Maine Lumbar Spine Study. Spine 26:1179–1187CrossRefPubMedGoogle Scholar
  4. 4.
    Atlas SJ, Keller RB, YA W, Deyo RA, Singer DE (2005) Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the maine lumbar spine study. Spine 30:927–935CrossRefPubMedGoogle Scholar
  5. 5.
    Eastwood GL (2009) When relatives and friends ask physicians for medical advice: ethical, legal, and practical considerations. J Gen Intern Med 24:1333–1335.  https://doi.org/10.1007/s11606-009-1127-1 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Forsth P, Olafsson G, Carlsson T, Frost A, Borgstrom F, Fritzell P, Ohagen P, Michaelsson K, Sanden B (2016) A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med 374:1413–1423.  https://doi.org/10.1056/NEJMoa1513721 CrossRefPubMedGoogle Scholar
  7. 7.
    Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, Castel LD, Kalsbeek WD, Carey TS (2009) The rising prevalence of chronic low back pain. Arch Intern Med 169:251–258.  https://doi.org/10.1001/archinternmed.2008.543 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Ghogawala Z, Dziura J, Butler WE, Dai F, Terrin N, Magge SN, Coumans JV, Harrington JF, Amin-Hanjani S, Schwartz JS, Sonntag VK, Barker FG 2nd, Benzel EC (2016) Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med 374:1424–1434.  https://doi.org/10.1056/NEJMoa1508788 CrossRefPubMedGoogle Scholar
  9. 9.
    Grauer JN, Vaccaro AR, Beiner JM, Kwon BK, Hilibrand AS, Harrop JS, Anderson G, Hurlbert J, Fehlings MG, Ludwig SC, Hedlund R, Arnold PM, Bono CM, Brodke DS, Dvorak MF, Fischer CG, Sledge JB, Shaffrey CI, Schwartz DG, Sears WR, Dickman C, Sharan A, Albert TJ, Rechtine GR 2nd (2004) Similarities and differences in the treatment of spine trauma between surgical specialties and location of practice. Spine 29:685–696CrossRefPubMedGoogle Scholar
  10. 10.
    Hestbaek L, Leboeuf-Yde C, Manniche C (2003) Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J 12:149–165.  https://doi.org/10.1007/s00586-002-0508-5 PubMedPubMedCentralGoogle Scholar
  11. 11.
    Hussain M, Nasir S, Moed A, Murtaza G (2011) Variations in practice patterns among neurosurgeons and orthopaedic surgeons in the management of spinal disorders. Asian Spine J 5:208–212.  https://doi.org/10.4184/asj.2011.5.4.208 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Irwin ZN, Hilibrand A, Gustavel M, McLain R, Shaffer W, Myers M, Glaser J, Hart RA (2005) Variation in surgical decision making for degenerative spinal disorders. Part I: lumbar spine. Spine 30:2208–2213CrossRefPubMedGoogle Scholar
  13. 13.
    Jacobs WC, Arts MP, van Tulder MW, Rubinstein SM, van Middelkoop M, Ostelo RW, Verhagen AP, Koes BW, Peul WC (2012) Surgical techniques for sciatica due to herniated disc, a systematic review. Eur Spine J 21:2232–2251.  https://doi.org/10.1007/s00586-012-2422-9 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Kerrigan J, Rovelstad S, Kodner IJ, La Puma J, Keune JD (2011) All in the family: how close is too close? The ethics of treating loved ones. Surgery 149:433–437CrossRefPubMedGoogle Scholar
  15. 15.
    Klein MC (1997) Too close for comfort? A family physician questions whether medical professionals should be excluded from their loved ones' care. CMAJ 156:53–55PubMedPubMedCentralGoogle Scholar
  16. 16.
    Krall EJ (2008) Doctors who doctor self, family, and colleagues. WMJ 107:279–284PubMedGoogle Scholar
  17. 17.
    La Puma J, Stocking CB, La Voie D, Darling CA (1991) When physicians treat members of their own families. Practices in a community hospital. N Engl J Med 325:1290–1294.  https://doi.org/10.1056/NEJM199110313251806 CrossRefPubMedGoogle Scholar
  18. 18.
    Lequin MB, Verbaan D, Jacobs WC, Brand R, Bouma GJ, Vandertop WP, Peul WC, Leiden-The Hague Spine Intervention Prognostic Study G, Wcp, Bwk, Rtwmt, WbvdH, Rb (2013) Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial. BMJ Open 3.  https://doi.org/10.1136/bmjopen-2012-002534
  19. 19.
    Lubelski D, Williams SK, O'Rourke C, Obuchowski NA, Wang JC, Steinmetz MP, Melillo AJ, Benzel EC, Modic MT, Quencer R, Mroz TE (2016) Differences in the surgical treatment of lower back pain among spine surgeons in the United States. Spine 41:978–986.  https://doi.org/10.1097/BRS.0000000000001396 CrossRefPubMedGoogle Scholar
  20. 20.
    Lurie JD, Tosteson TD, Tosteson AN, Zhao W, Morgan TS, Abdu WA, Herkowitz H, Weinstein JN (2014) Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial. Spine 39:3–16.  https://doi.org/10.1097/BRS.0000000000000088 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Lurie JD, Tosteson TD, Tosteson A, Abdu WA, Zhao W, Morgan TS, Weinstein JN (2015) Long-term outcomes of lumbar spinal stenosis: eight-year results of the Spine Patient Outcomes Research Trial (SPORT). Spine 40:63–76.  https://doi.org/10.1097/BRS.0000000000000731 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Minhas SV, Chow I, Patel AA, Kim JY (2014) Surgeon specialty differences in single-level anterior cervical discectomy and fusion. Spine 39:1648–1655.  https://doi.org/10.1097/BRS.0000000000000499 CrossRefPubMedGoogle Scholar
  23. 23.
    Mroz TE, Lubelski D, Williams SK, O'Rourke C, Obuchowski NA, Wang JC, Steinmetz MP, Melillo AJ, Benzel EC, Modic MT, Quencer RM (2014) Differences in the surgical treatment of recurrent lumbar disc herniation among spine surgeons in the United States. Spine J 14:2334–2343.  https://doi.org/10.1016/j.spinee.2014.01.037 CrossRefPubMedGoogle Scholar
  24. 24.
    Peul WC, van Houwelingen HC, van den Hout WB, Brand R, Eekhof JA, Tans JT, Thomeer RT, Koes BW, Leiden-The Hague Spine Intervention Prognostic Study G (2007) Surgery versus prolonged conservative treatment for sciatica. N Engl J Med 356:2245–2256.  https://doi.org/10.1056/NEJMoa064039 CrossRefPubMedGoogle Scholar
  25. 25.
    Peul WC, van den Hout WB, Brand R, Thomeer RT, Koes BW, Leiden-The Hague Spine Intervention Prognostic Study G (2008) Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial. BMJ 336:1355–1358.  https://doi.org/10.1136/bmj.a143 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Reagan B, Reagan P, Sinclair A (1994) Common sense and a thick hide'. Physicians providing care to their own family members. Arch Fam Med 3:599–604CrossRefPubMedGoogle Scholar
  27. 27.
    Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976) 33:931–939.  https://doi.org/10.1097/BRS.0b013e31816c8af7 CrossRefGoogle Scholar
  28. 28.
    Seicean A, Alan N, Seicean S, Neuhauser D, Benzel EC, Weil RJ (2014) Surgeon specialty and outcomes after elective spine surgery. Spine 39:1605–1613.  https://doi.org/10.1097/BRS.0000000000000489 CrossRefPubMedGoogle Scholar
  29. 29.
    Thomas KC, Fisher CG, Boyd M, Bishop P, Wing P, Dvorak MF (2007) Outcome evaluation of surgical and nonsurgical management of lumbar disc protrusion causing radiculopathy. Spine 32:1414–1422.  https://doi.org/10.1097/BRS.0b013e318060a5d1 CrossRefPubMedGoogle Scholar
  30. 30.
    Thome C, Barth M, Scharf J, Schmiedek P (2005) Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study. J Neurosurg Spine 2:271–278.  https://doi.org/10.3171/spi.2005.2.3.0271 CrossRefPubMedGoogle Scholar
  31. 31.
    Tosteson AN, Tosteson TD, Lurie JD, Abdu W, Herkowitz H, Andersson G, Albert T, Bridwell K, Zhao W, Grove MR, Weinstein MC, Weinstein JN (2011) Comparative effectiveness evidence from the spine patient outcomes research trial: surgical versus nonoperative care for spinal stenosis, degenerative spondylolisthesis, and intervertebral disc herniation. Spine (Phila Pa 1976) 36:2061–2068.  https://doi.org/10.1097/BRS.0b013e318235457b CrossRefGoogle Scholar
  32. 32.
    Walker BF (2000) The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord 13:205–217CrossRefPubMedGoogle Scholar
  33. 33.
    Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Hanscom B, Skinner JS, Abdu WA, Hilibrand AS, Boden SD, Deyo RA (2006) Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA 296:2441–2450.  https://doi.org/10.1001/jama.296.20.2441 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, Birkmeyer NJ, Hilibrand AS, Herkowitz H, Cammisa FP, Albert TJ, Emery SE, Lenke LG, Abdu WA, Longley M, Errico TJ, SS H (2007) Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 356:2257–2270.  https://doi.org/10.1056/NEJMoa070302 CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Weinstein JN, Lurie JD, Tosteson TD, Tosteson AN, Blood EA, Abdu WA, Herkowitz H, Hilibrand A, Albert T, Fischgrund J (2008) Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine 33:2789–2800.  https://doi.org/10.1097/BRS.0b013e31818ed8f4 CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H, Investigators S (2008) Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 358:794–810.  https://doi.org/10.1056/NEJMoa0707136 CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Weinstein JN, Lurie JD, Tosteson TD, Zhao W, Blood EA, Tosteson AN, Birkmeyer N, Herkowitz H, Longley M, Lenke L, Emery S, SS H (2009) Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. Four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am 91:1295–1304.  https://doi.org/10.2106/JBJS.H.00913 CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Weinstein JN, Tosteson TD, Lurie JD, Tosteson A, Blood E, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H (2010) Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine 35:1329–1338.  https://doi.org/10.1097/BRS.0b013e3181e0f04d CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Nico Sollmann
    • 1
    • 2
    • 3
  • Carmen Morandell
    • 1
  • Lucia Albers
    • 1
    • 4
  • Michael Behr
    • 1
  • Alexander Preuss
    • 1
  • Andreas Dinkel
    • 5
  • Bernhard Meyer
    • 1
  • Sandro M. Krieg
    • 1
    • 2
  1. 1.Department of Neurosurgery, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
  2. 2.TUM-Neuroimaging Center, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
  3. 3.Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der IsarTechnische Universität München81675 MunichGermany
  4. 4.Institute of Social Pediatrics and Adolescents MedicineLudwig-Maximilians-Universität München80336 MunichGermany
  5. 5.Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany

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