Different Spine Surgery Recommendations
In the October 2014 Spine Journal, there was a fascinating Study presented by Dr. Mroz of the Cleveland Clinic regarding “Differences in the surgical treatment of recurrent lumbar disk herniation among spine surgeon in the United States”.
The study identified significant differences among US spine surgeons, regarding the use of Lumbar spinal fusion in combination with repeat removal of a disk, versus just repeating a removal of a disk. The study concludes:
1. Surgeons in practice for more than 15 years will more likely chose to just remove the disk without fusion.
2. Surgeons with a larger surgical volume will also chose to fuse the spine as well as remove the disk.
Unfortunately, these conclusions tend to support the stereotype of the “young aggressive surgeon”.
To be fair, the study did look and compare the results of surgeon preference for surgical management in for first time recurrent disk herniations, and there was a better consensus that repeat removal of the disk is the preferred method.
The much larger difference was identified when there is a second recurrent disk herniation.
The study was a collection of data via an on-line survey of spine surgeons. Of the total of 2460 surgeons surveyed, only 445 completed the questionnaire. Questions identified the geography of the surgeon, the duration of practice, whether the surgeon was fellowship trained, whether the surgeon was in an academic practice, and the number of spine surgeries performed each year.
Analysis of the data did not show any difference in the surgery preferences in terms of fellowship training, academic practice, or geography.
The study demonstrates that surgeons can have significant differences in surgical recommendation for the same set of findings. For patients, it certainly confirms the age old recommendation of seeking second opinions about major spine surgery.
- Mroz TE, Lubelski D, Williams SK, O'Rourke C, Obuchowski NA, Wang JC, Steinmetz MP, Melillo AJ, Benzel EC, Modic MT, Quencer RM. Differences in the surgical treatment of recurrent lumbar disc herniation among spine surgeons in the United States. Spine J. 2014 Oct 1;14(10):2334-43. PubMed PMID: 24462813