Emre Acaroğlu1, Tiro Mmopelwa2, Selcen Yüksel3, Selim Ayhan4, Margareta Nordin5,6, Kristi Randhawa7, Scott Haldeman8,9. 1. ARTES Spine Center, Ankara, Turkey. acaroglue@gmail.com. 2. ARTES Spine Centre Ankara, Life Gaborone Hospital, Gaborone, Botswana. 3. Department of Biostatistics, Ankara Yildirim Beyazit University Medical School, Ankara, Turkey. 4. ARTES Spine Center, Ankara, Turkey. 5. Department of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA. 6. World Spine Care Europe, Holmfirth, UK. 7. University of Ontario Institute of Technology (UOIT)-Canadian Memorial Chiropractic College (CMCC) Centre for Disability Prevention and Rehabilitation, Toronto, ON, Canada. 8. Department of Epidemiology, School of Public Health, University of California Los Angeles, Santa Ana, CA, USA. 9. Department of Neurology, University of California, Irvine and President, World Spine Care, Santa Ana, CA, USA.
Abstract
PURPOSE: The purpose of this study was to develop a stratification scheme for surgical spinal care to serve as a framework for referrals and distribution of patients with spinal disorders. METHODS: We used a modified Delphi process. A literature search identified experts for the consensus panel and the panel was expanded by inviting spine surgeons known to be global opinion leaders. After creating a seed document of five hierarchical levels of surgical care, a four-step modified Delphi process (question validation, collection of factors, evaluation of factors, re-evaluation of factors) was performed. RESULTS: Of 78 invited experts, 19 participated in round 1, and of the 19, 14 participated in 2, and 12 in 3 and 4. Consensus was fairly heterogeneous for levels of care 2-4 (moderate resources). Only simple assessment methods based on the clinical skills of the medical personnel were considered feasible and safe in low-resource settings. Diagnosis, staging, and treatment were deemed feasible and safe in a specialized spine center. Accurate diagnostic workup was deemed feasible and safe for lower levels of care complexity (from level 3 upwards) compared to non-invasive procedures (level 4) and the full range of invasive procedures (level 5). CONCLUSION: This study introduces a five-level stratification scheme for the surgical care of spinal disorders. This stratification may provide input into the Global Spine Care Initiative care pathway that will be applied in medically underserved areas and low- and middle-income countries. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: The purpose of this study was to develop a stratification scheme for surgical spinal care to serve as a framework for referrals and distribution of patients with spinal disorders. METHODS: We used a modified Delphi process. A literature search identified experts for the consensus panel and the panel was expanded by inviting spine surgeons known to be global opinion leaders. After creating a seed document of five hierarchical levels of surgical care, a four-step modified Delphi process (question validation, collection of factors, evaluation of factors, re-evaluation of factors) was performed. RESULTS: Of 78 invited experts, 19 participated in round 1, and of the 19, 14 participated in 2, and 12 in 3 and 4. Consensus was fairly heterogeneous for levels of care 2-4 (moderate resources). Only simple assessment methods based on the clinical skills of the medical personnel were considered feasible and safe in low-resource settings. Diagnosis, staging, and treatment were deemed feasible and safe in a specialized spine center. Accurate diagnostic workup was deemed feasible and safe for lower levels of care complexity (from level 3 upwards) compared to non-invasive procedures (level 4) and the full range of invasive procedures (level 5). CONCLUSION: This study introduces a five-level stratification scheme for the surgical care of spinal disorders. This stratification may provide input into the Global Spine Care Initiative care pathway that will be applied in medically underserved areas and low- and middle-income countries. These slides can be retrieved under Electronic Supplementary Material.
Entities:
Keywords:
Delivery of health care; General surgery; Health care facilities, manpower, and services; Operative; Spine; Surgical procedures
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Eric M Fèvre; Mariel M Finucane; Seth Flaxman; Louise Flood; Kyle Foreman; Mohammad H Forouzanfar; Francis Gerry R Fowkes; Marlene Fransen; Michael K Freeman; Belinda J Gabbe; Sherine E Gabriel; Emmanuela Gakidou; Hammad A Ganatra; Bianca Garcia; Flavio Gaspari; Richard F Gillum; Gerhard Gmel; Diego Gonzalez-Medina; Richard Gosselin; Rebecca Grainger; Bridget Grant; Justina Groeger; Francis Guillemin; David Gunnell; Ramyani Gupta; Juanita Haagsma; Holly Hagan; Yara A Halasa; Wayne Hall; Diana Haring; Josep Maria Haro; James E Harrison; Rasmus Havmoeller; Roderick J Hay; Hideki Higashi; Catherine Hill; Bruno Hoen; Howard Hoffman; Peter J Hotez; Damian Hoy; John J Huang; Sydney E Ibeanusi; Kathryn H Jacobsen; Spencer L James; Deborah Jarvis; Rashmi Jasrasaria; Sudha Jayaraman; Nicole Johns; Jost B Jonas; Ganesan Karthikeyan; Nicholas Kassebaum; Norito Kawakami; Andre Keren; Jon-Paul Khoo; Charles H King; Lisa Marie Knowlton; Olive Kobusingye; Adofo Koranteng; Rita Krishnamurthi; Francine Laden; 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Charles R Newton; Sandra Nolte; Paul Norman; Rosana Norman; Martin O'Donnell; Simon O'Hanlon; Casey Olives; Saad B Omer; Katrina Ortblad; Richard Osborne; Doruk Ozgediz; Andrew Page; Bishnu Pahari; Jeyaraj Durai Pandian; Andrea Panozo Rivero; Scott B Patten; Neil Pearce; Rogelio Perez Padilla; Fernando Perez-Ruiz; Norberto Perico; Konrad Pesudovs; David Phillips; Michael R Phillips; Kelsey Pierce; Sébastien Pion; Guilherme V Polanczyk; Suzanne Polinder; C Arden Pope; Svetlana Popova; Esteban Porrini; Farshad Pourmalek; Martin Prince; Rachel L Pullan; Kapa D Ramaiah; Dharani Ranganathan; Homie Razavi; Mathilda Regan; Jürgen T Rehm; David B Rein; Guiseppe Remuzzi; Kathryn Richardson; Frederick P Rivara; Thomas Roberts; Carolyn Robinson; Felipe Rodriguez De Leòn; Luca Ronfani; Robin Room; Lisa C Rosenfeld; Lesley Rushton; Ralph L Sacco; Sukanta Saha; Uchechukwu Sampson; Lidia Sanchez-Riera; Ella Sanman; David C Schwebel; James Graham Scott; Maria Segui-Gomez; Saeid Shahraz; Donald S Shepard; Hwashin Shin; Rupak Shivakoti; David Singh; Gitanjali M Singh; Jasvinder A Singh; Jessica Singleton; David A Sleet; Karen Sliwa; Emma Smith; Jennifer L Smith; Nicolas J C Stapelberg; Andrew Steer; Timothy Steiner; Wilma A Stolk; Lars Jacob Stovner; Christopher Sudfeld; Sana Syed; Giorgio Tamburlini; Mohammad Tavakkoli; Hugh R Taylor; Jennifer A Taylor; William J Taylor; Bernadette Thomas; W Murray Thomson; George D Thurston; Imad M Tleyjeh; Marcello Tonelli; Jeffrey A Towbin; Thomas Truelsen; Miltiadis K Tsilimbaris; Clotilde Ubeda; Eduardo A Undurraga; Marieke J van der Werf; Jim van Os; Monica S Vavilala; N Venketasubramanian; Mengru Wang; Wenzhi Wang; Kerrianne Watt; David J Weatherall; Martin A Weinstock; Robert Weintraub; Marc G Weisskopf; Myrna M Weissman; Richard A White; Harvey Whiteford; Natasha Wiebe; Steven T Wiersma; James D Wilkinson; Hywel C Williams; Sean R M Williams; Emma Witt; Frederick Wolfe; Anthony D Woolf; Sarah Wulf; Pon-Hsiu Yeh; Anita K M Zaidi; Zhi-Jie Zheng; David Zonies; Alan D Lopez; Mohammad A AlMazroa; Ziad A Memish Journal: Lancet Date: 2012-12-15 Impact factor: 79.321
Authors: Scott Haldeman; Claire D Johnson; Roger Chou; Margareta Nordin; Pierre Côté; Eric L Hurwitz; Bart N Green; Deborah Kopansky-Giles; Christine Cedraschi; Ellen Aartun; Emre Acaroğlu; Arthur Ameis; Selim Ayhan; Fiona Blyth; David Borenstein; O'Dane Brady; Fereydoun Davatchi; Christine Goertz; Najia Hajjaj-Hassouni; Jan Hartvigsen; Maria Hondras; Nadège Lemeunier; John Mayer; Silvano Mior; Tiro Mmopelwa; Michael Modic; Rajani Mullerpatan; Lillian Mwaniki; Madeleine Ngandeu-Singwe; Geoff Outerbridge; Kristi Randhawa; Erkin Sönmez; Carlos Torres; Paola Torres; William Watters; Hainan Yu Journal: Eur Spine J Date: 2018-08-27 Impact factor: 3.134
Authors: Claire D Johnson; Scott Haldeman; Margareta Nordin; Roger Chou; Pierre Côté; Eric L Hurwitz; Bart N Green; Deborah Kopansky-Giles; Kristi Randhawa; Christine Cedraschi; Arthur Ameis; Emre Acaroğlu; Ellen Aartun; Afua Adjei-Kwayisi; Selim Ayhan; Amer Aziz; Teresa Bas; Fiona Blyth; David Borenstein; O'Dane Brady; Peter Brooks; Connie Camilleri; Juan M Castellote; Michael B Clay; Fereydoun Davatchi; Jean Dudler; Robert Dunn; Stefan Eberspaecher; Juan Emmerich; Jean Pierre Farcy; Norman Fisher-Jeffes; Christine Goertz; Michael Grevitt; Erin A Griffith; Najia Hajjaj-Hassouni; Jan Hartvigsen; Maria Hondras; Edward J Kane; Julie Laplante; Nadège Lemeunier; John Mayer; Silvano Mior; Tiro Mmopelwa; Michael Modic; Jean Moss; Rajani Mullerpatan; Elijah Muteti; Lillian Mwaniki; Madeleine Ngandeu-Singwe; Geoff Outerbridge; Shanmuganathan Rajasekaran; Heather Shearer; Matthew Smuck; Erkin Sönmez; Patricia Tavares; Anne Taylor-Vaisey; Carlos Torres; Paola Torres; Alexander van der Horst; Leslie Verville; Emiliano Vialle; Gomatam Vijay Kumar; Adriaan Vlok; William Watters; Chung Chek Wong; Jessica J Wong; Hainan Yu; Selcen Yüksel Journal: Eur Spine J Date: 2018-08-27 Impact factor: 3.134
Authors: Scott Haldeman; Claire D Johnson; Roger Chou; Margareta Nordin; Pierre Côté; Eric L Hurwitz; Bart N Green; Christine Cedraschi; Emre Acaroğlu; Deborah Kopansky-Giles; Arthur Ameis; Afua Adjei-Kwayisi; Selim Ayhan; Fiona Blyth; David Borenstein; O'Dane Brady; Peter Brooks; Connie Camilleri; Juan M Castellote; Michael B Clay; Fereydoun Davatchi; Robert Dunn; Christine Goertz; Erin A Griffith; Maria Hondras; Edward J Kane; Nadège Lemeunier; John Mayer; Tiro Mmopelwa; Michael Modic; Jean Moss; Rajani Mullerpatan; Elijah Muteti; Lillian Mwaniki; Madeleine Ngandeu-Singwe; Geoff Outerbridge; Kristi Randhawa; Heather Shearer; Erkin Sönmez; Carlos Torres; Paola Torres; Leslie Verville; Adriaan Vlok; William Watters; Chung Chek Wong; Hainan Yu Journal: Eur Spine J Date: 2018-08-27 Impact factor: 3.134
Authors: Claire D Johnson; Scott Haldeman; Roger Chou; Margareta Nordin; Bart N Green; Pierre Côté; Eric L Hurwitz; Deborah Kopansky-Giles; Emre Acaroğlu; Christine Cedraschi; Arthur Ameis; Kristi Randhawa; Ellen Aartun; Afua Adjei-Kwayisi; Selim Ayhan; Amer Aziz; Teresa Bas; Fiona Blyth; David Borenstein; O'Dane Brady; Peter Brooks; Connie Camilleri; Juan M Castellote; Michael B Clay; Fereydoun Davatchi; Jean Dudler; Robert Dunn; Stefan Eberspaecher; Juan Emmerich; Jean Pierre Farcy; Norman Fisher-Jeffes; Christine Goertz; Michael Grevitt; Erin A Griffith; Najia Hajjaj-Hassouni; Jan Hartvigsen; Maria Hondras; Edward J Kane; Julie Laplante; Nadège Lemeunier; John Mayer; Silvano Mior; Tiro Mmopelwa; Michael Modic; Jean Moss; Rajani Mullerpatan; Elijah Muteti; Lillian Mwaniki; Madeleine Ngandeu-Singwe; Geoff Outerbridge; Shanmuganathan Rajasekaran; Heather Shearer; Matthew Smuck; Erkin Sönmez; Patricia Tavares; Anne Taylor-Vaisey; Carlos Torres; Paola Torres; Alexander van der Horst; Leslie Verville; Emiliano Vialle; Gomatam Vijay Kumar; Adriaan Vlok; William Watters; Chung Chek Wong; Jessica J Wong; Hainan Yu; Selcen Yüksel Journal: Eur Spine J Date: 2018-08-27 Impact factor: 3.134
Authors: Deborah Kopansky-Giles; Claire D Johnson; Scott Haldeman; Roger Chou; Pierre Côté; Bart N Green; Margareta Nordin; Emre Acaroğlu; Arthur Ameis; Christine Cedraschi; Eric L Hurwitz; Selim Ayhan; David Borenstein; O'Dane Brady; Peter Brooks; Fereydoun Davatchi; Robert Dunn; Christine Goertz; Najia Hajjaj-Hassouni; Jan Hartvigsen; Maria Hondras; Nadège Lemeunier; John Mayer; Silvano Mior; Jean Moss; Rajani Mullerpatan; Elijah Muteti; Lillian Mwaniki; Madeleine Ngandeu-Singwe; Geoff Outerbridge; Kristi Randhawa; Carlos Torres; Paola Torres; Adriaan Vlok; Chung Chek Wong Journal: Eur Spine J Date: 2018-08-27 Impact factor: 3.134
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Authors: Madiha Ijaz; Muhammad Akram; Sajid Rashid Ahmad; Kamran Mirza; Falaq Ali Nadeem; Steven M Thygerson Journal: Int J Environ Res Public Health Date: 2020-06-09 Impact factor: 3.390