• Daniel Lubelski, Vincent J Alentado, Seth K Williams, Colin O'Rourke, Nancy A Obuchowski, Jeffrey C Wang, Michael P Steinmetz, Alfred J Melillo, Edward C Benzel, Michael T Modic, Robert Quencer, and Thomas E Mroz.
• Center for Spine Health and the Department of Neurosurgery Cleveland Clinic, Cleveland, Ohio, USA; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA. Electronic address: dlubelski@jhmi.edu.
• World Neurosurg. 2018 Mar 1; 111: e564-e572.

BackgroundThere are a multitude of treatments for low-grade lumbar spondylolisthesis. There are no clear guidelines for the optimal approach.ObjectiveTo identify the surgical treatment patterns for spondylolisthesis among United States spine surgeons.Methods445 spine surgeons in the United States completed a survey of clinical/radiographic case scenarios on patients with lumbar spondylolisthesis with neurogenic claudication with (S+BP) or without (S-BP) associated mechanical back pain. Treatment options included decompression, laminectomy with posterolateral fusion, posterior lumbar interbody fusion, or none of the above. The primary outcome measure was the probability of 2 randomly chosen surgeons disagreeing on the treatment method.ResultsThere was 64% disagreement (36% agreement) among surgeons for treatment of spondylolisthesis with mechanical back pain (S+BP) and 71% disagreement (29% agreement) for spondylolisthesis without mechanical back pain (S-BP). For S+BP, disagreement was 52% for those practicing 5 to 10 years versus 70% among those practicing more than 20 years. Orthopedic surgeons had greater disagreement than did neurosurgeons (76% vs. 56%) for S+BP. Greater clinical equipoise was seen for S-BP than for S+BP regardless of surgeon characteristics. For spondylolisthesis without mechanical back pain, neurosurgeons were significantly more likely to select decompression-only than were orthopedic surgeons, who more commonly selected fusion.ConclusionsClinical equipoise exists for the treatment of spondylolisthesis. Differences are greater when the patient presents without associated back pain. Surgeon case volume, practice duration, and specialty training influence operative decisions for a given pathologic condition. Recognizing this practice variation will hopefully lead to better evidence and practice guidelines for the optimal and most cost-effective treatment paradigms.Copyright © 2017 Elsevier Inc. All rights reserved.

26 keywords...

hide…