Kai-Uwe Lewandrowski1,2, José-Antonio Soriano-Sánchez3, Xifeng Zhang4, Jorge Felipe Ramírez León5,6, Sergio Soriano Solis7, José Gabriel Rugeles Ortíz8, Gabriel Oswaldo Alonso Cuéllar9, Marlon Sudário de Lima E Silva10, Stefan Hellinger11, Álvaro Dowling12,13, Nicholas Prada14, Gun Choi15, Girish Datar16, Anthony Yeung17,18. 1. Center for Advanced Spine Care of Southern Arizona, Surgical Institute of Tucson, Tucson, AZ, USA. 2. Department Neurosurgery, UNIRIO, Rio de Janeiro, Brazil. 3. The Spine Clinic, Neurological Center, ABC Medical Center, Mexico City, Mexico. 4. Orthopaedic Surgeon, The Chinese PLA General Hospital, Beijing 100000, China. 5. Orthopedic & Minimally Invasive Spine Surgeon, Reina Sofía Clinic & Center of Minimally Invasive Spine Surgery, Bogotá, D.C., Colombia. 6. Spine Surgery Program, Universidad Sanitas, Bogotá, D.C., Colombia. 7. ABC Medical Center, Campus Santa Fe, Mexico City, Mexico. 8. Universidad Sanitas, Bogotá, D.C., Colombia. 9. Center of Minimally Invasive Spine Surgery, Bogotá, D.C., Colombia. 10. CLINCOL (Endoscopic Spine Clinic), Belo Horizonte, Minas Gerais, Brazil. 11. Isar Medizin Zentrum, 80331 München, Germany. 12. Orthopaedic Spine Surgeon, Endoscopic Spine Clinic, Santiago, Chile. 13. Department of Orthopaedic Surgery, USP, Ribeirão Preto, Brazil. 14. Orthopaedic Spine Surgeon, Foscal Internacional Clinic, Bucaramanga, Colombia. 15. Orthopaedic Surgeon, Gun Hospital, Pohang, Korea. 16. Orthopaedic Surgeon, Center for Endoscopic Spine Surgery, Sushruta Hospital for Orthopaedics & Traumatology, Miraj, Sangli, Maharashtra, India. 17. University of New Mexico School of Medicine, Albuquerque, NM, USA. 18. Desert Institute for Spine Care, Phoenix, AZ, USA.
Abstract
BACKGROUND: Training of spine surgeons may impact the availability of contemporary minimally invasive spinal surgery (MIS) to patients and drive spine surgeons' clinical decision-making when applying minimally invasive spinal surgery techniques (MISST) to the treatment of common degenerative conditions of the lumbar spine. Training requirements and implementation of privileges vary in different parts of the world. The purpose of this study was to analyze the training in relation to practice patterns of surgeons who perform lumbar endoscopic spinal surgery the world over. METHODS: The authors solicited responses to an online survey sent to spine surgeons by email, and chat groups in social media networks including Facebook, WeChat, WhatsApp, and Linkedin. Surgeons were asked the following questions: (I) please indicate your training? (II) What type of MISST spinal surgery do you perform? (III) How would you rate your experience in MIS lumbar spinal surgery and what percentage of your practice is MISST? And (IV) which avenue did you use to train for the MISST you currently employ in your clinical practice today? Descriptive statistics were applied to count responses and cross-tabulated them to the surgeon's training. Pearson Chi-square measures, kappa statistics, and linear regression analysis of agreement or disagreement were performed by analyzing the distribution of variances using statistical package SPSS version 25.0. RESULTS: A total of 430 surgeons accessed the survey. The completion rate was 67.4%. Analyzing the responses of 292 surveys submitted by 97 neurosurgeons (33.2%), 161 orthopaedic surgeons (55.1%), and 34 surgeons of other postgraduate training (11.6%) showed that only 14% (41/292) of surgeons had completed a fellowship. Surgeons rated their skill level 33.5% of the time as master and experienced surgeon, and 35.6% of the time as novice or surgeon with some experience. There were more master (64.6% versus 29.2%) and experienced (52% versus 40%) surgeons amongst orthopaedic surgeons than amongst neurosurgeons at a statistically significant level (P=0.11). There were near twice as many orthopaedic surgeons (54.3%) using endoscopic procedures in the lumbar spine as their favorite MISST than neurosurgeons (35.4%; P=0.096). Endoscopic spine surgeons' main sources of knowledge acquisition were (I) learning in small meetings (57.3%), (II) attending workshops (63.1%), and (III) national and international conferences (59.8%). CONCLUSIONS: The majority of spine surgeons reported more than half of their cases employing MISST at a high skill level. Very few MISST surgeons are fellowship trained but attend workshops and various meetings suggesting that many of them are self-thought. Orthopaedic surgeons were more likely to implement endoscopic spinal surgery into the routine clinical practice. As endoscopic spine surgery gains more traction and patient demand, minimal adequate training will be part of the ongoing debate. 2020 Journal of Spine Surgery. All rights reserved.
BACKGROUND: Training of spine surgeons may impact the availability of contemporary minimally invasive spinal surgery (MIS) to patients and drive spine surgeons' clinical decision-making when applying minimally invasive spinal surgery techniques (MISST) to the treatment of common degenerative conditions of the lumbar spine. Training requirements and implementation of privileges vary in different parts of the world. The purpose of this study was to analyze the training in relation to practice patterns of surgeons who perform lumbar endoscopic spinal surgery the world over. METHODS: The authors solicited responses to an online survey sent to spine surgeons by email, and chat groups in social media networks including Facebook, WeChat, WhatsApp, and Linkedin. Surgeons were asked the following questions: (I) please indicate your training? (II) What type of MISST spinal surgery do you perform? (III) How would you rate your experience in MIS lumbar spinal surgery and what percentage of your practice is MISST? And (IV) which avenue did you use to train for the MISST you currently employ in your clinical practice today? Descriptive statistics were applied to count responses and cross-tabulated them to the surgeon's training. Pearson Chi-square measures, kappa statistics, and linear regression analysis of agreement or disagreement were performed by analyzing the distribution of variances using statistical package SPSS version 25.0. RESULTS: A total of 430 surgeons accessed the survey. The completion rate was 67.4%. Analyzing the responses of 292 surveys submitted by 97 neurosurgeons (33.2%), 161 orthopaedic surgeons (55.1%), and 34 surgeons of other postgraduate training (11.6%) showed that only 14% (41/292) of surgeons had completed a fellowship. Surgeons rated their skill level 33.5% of the time as master and experienced surgeon, and 35.6% of the time as novice or surgeon with some experience. There were more master (64.6% versus 29.2%) and experienced (52% versus 40%) surgeons amongst orthopaedic surgeons than amongst neurosurgeons at a statistically significant level (P=0.11). There were near twice as many orthopaedic surgeons (54.3%) using endoscopic procedures in the lumbar spine as their favorite MISST than neurosurgeons (35.4%; P=0.096). Endoscopic spine surgeons' main sources of knowledge acquisition were (I) learning in small meetings (57.3%), (II) attending workshops (63.1%), and (III) national and international conferences (59.8%). CONCLUSIONS: The majority of spine surgeons reported more than half of their cases employing MISST at a high skill level. Very few MISST surgeons are fellowship trained but attend workshops and various meetings suggesting that many of them are self-thought. Orthopaedic surgeons were more likely to implement endoscopic spinal surgery into the routine clinical practice. As endoscopic spine surgery gains more traction and patient demand, minimal adequate training will be part of the ongoing debate. 2020 Journal of Spine Surgery. All rights reserved.
Entities:
Keywords:
Lumbar minimally invasive spinal surgery (lumbar MIS); spinal endoscopy; training and credentialing
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