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

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

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.

Original languageEnglish
Pages (from-to)425-438
Number of pages14
JournalActa Neurochirurgica
Volume160
Issue number3
DOIs
StatePublished - 1 Mar 2018
Externally publishedYes

Keywords

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

Fingerprint

Dive into the research topics of 'Association of decision-making in spinal surgery with specialty and emotional involvement—the Indications in Spinal Surgery (INDIANA) survey'. Together they form a unique fingerprint.

Cite this