Variability in Surgical Treatment of Spondylolisthesis among Spine Surgeons.

Variability in Surgical Treatment of Spondylolisthesis among Spine Surgeons.

World Neurosurg. 2017 Dec 27;:

Authors: Lubelski D, Alentado V, Williams S, O'Rourke C, Obuchowski N, Wang JC, Steinmetz M, Melillo A, Benzel E, Modic M, Quencer R, Mroz T

Abstract
BACKGROUND: There are a multitude of treatments for low grade lumbar spondylolisthesis. There are no clear guidelines for the optimal approach.
OBJECTIVE: To identify the surgical treatment patterns for spondylolisthesis, among United States spine surgeons METHODS: 445 US spine surgeons 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 two randomly chosen surgeons disagreeing on the treatment method.
RESULTS: There 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 5-10 years versus 70% among those practicing >20 years. Orthopedic surgeons had greater disagreement compared to neurosurgeons (76% vs 56%) for S+BP. Greater clinical equipoise was seen for S-BP compared to S+BP regardless of surgeon characteristics. For spondylolisthesis without mechanical back pain, neurosurgeons were significantly more likely to select decompression-only as compared to orthopedic surgeons who more commonly fused.
CONCLUSIONS: Clinical 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 pathology. Recognizing this practice variation will hopefully lead to better evidence and practice guidelines for the optimal and most cost effective treatment paradigms.

PMID: 29288862 [PubMed - as supplied by publisher]

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