Kai-Uwe Lewandrowski1,2,3, José-Antonio Soriano-Sánchez4, Xifeng Zhang5, Jorge Felipe Ramírez León3,6, Sergio Soriano Solis4, José Gabriel Rugeles Ortíz3,6, Carolina Ramírez Martínez3, Gabriel Oswaldo Alonso Cuéllar7, Kaixuan Liu8, Qiang Fu9, Marlon Sudário de Lima E Silva10, Paulo Sérgio Teixeira de Carvalho11, Stefan Hellinger12, Álvaro Dowling13,14, Nicholas Prada15, Gun Choi16, Girish Datar17, Anthony Yeung18,19. 1. Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson, AZ, USA. 2. Department Neurosurgery, UNIRIO, Rio de Janeiro, Brazil. 3. Spine Surgery Program, Universidad Sanitas, Bogotá, D.C., Colombia. 4. Spine Clinic, Neurological Center, ABC Medical Center, Mexico City, Mexico. 5. The Chinese PLA General Hospital, Beijing 100853, China. 6. Reina Sofía Clinic & Center of Minimally Invasive Spine Surgery, Bogotá, Colombia. 7. Center of Minimally Invasive Spine Surgery, Bogotá, Colombia. 8. Atlantic Spine Center, West Orange, NJ, USA. 9. Department of Orthopedics, Shanghai General Hospital, Shanghai, China. 10. Endoscopic Spine Clinic, Belo Horizonte, Minas Gerais, Brazil. 11. Department of Neurosurgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. 12. Orthopaedic Surgeon, München, Germany. 13. Endoscopic Spine Clinic, Santiago, Chile. 14. Department of Orthopaedic Surgery, USP, Ribeirão Preto, Brazil. 15. Foscal International Clinic, Florida, USA. 16. Gun Hospital, Pohang, Korea. 17. Center for Endoscopic Spine Surgery, Sushruta Hospital for Orthopaedics & Traumatology, Miraj, Sangli, Maharashtra, India. 18. University of New Mexico School of Medicine, Albuquerque, New Mexico. 19. Desert Institute for Spine Care, Phoenix, AZ, USA.
Abstract
BACKGROUND: This study aimed to analyze the motivators and obstacles to the implementation of minimally invasive spinal surgery techniques (MISST) by spinal surgeons. Motivators and detractors may impact the availability of MISST to patients and drive spine surgeons' clinical decision-making in the treatment of common degenerative conditions of the lumbar spine. 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. Descriptive statistics were employed to count the responses and compared to the surgeon's training. Kappa statistics and linear regression analysis of agreement were performed. RESULTS: A total of 430 surgeons accessed the survey. The completion rate was 67.4%. A total of 292 surveys were submitted by 99 neurosurgeons (33.9%), 170 orthopaedic surgeons (58.2%), and 23 surgeons of other postgraduate training (7.9%). Personal interest (82.5%) and patient demand (48.6%) were the primary motivators for MISST implementation. High equipment (48.3%) and disposables (29.1%) cost were relevant obstacles to MISST implementation. Local workshops (47.6%) and meetings in small groups (31.8%) were listed as the primary knowledge sources. Only 12% of surgeons were fellowship trained, but 46.3% of surgeons employed MISST in over 25% of their cases. CONCLUSIONS: The rate of implementation of MISST reported by spine surgeons was found to be high but impeded by the high cost of equipment and disposables. The primary motivators for spine surgeons' desire to implement were personal interest and patient demand. 2020 Journal of Spine Surgery. All rights reserved.
BACKGROUND: This study aimed to analyze the motivators and obstacles to the implementation of minimally invasive spinal surgery techniques (MISST) by spinal surgeons. Motivators and detractors may impact the availability of MISST to patients and drive spine surgeons' clinical decision-making in the treatment of common degenerative conditions of the lumbar spine. 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. Descriptive statistics were employed to count the responses and compared to the surgeon's training. Kappa statistics and linear regression analysis of agreement were performed. RESULTS: A total of 430 surgeons accessed the survey. The completion rate was 67.4%. A total of 292 surveys were submitted by 99 neurosurgeons (33.9%), 170 orthopaedic surgeons (58.2%), and 23 surgeons of other postgraduate training (7.9%). Personal interest (82.5%) and patient demand (48.6%) were the primary motivators for MISST implementation. High equipment (48.3%) and disposables (29.1%) cost were relevant obstacles to MISST implementation. Local workshops (47.6%) and meetings in small groups (31.8%) were listed as the primary knowledge sources. Only 12% of surgeons were fellowship trained, but 46.3% of surgeons employed MISST in over 25% of their cases. CONCLUSIONS: The rate of implementation of MISST reported by spine surgeons was found to be high but impeded by the high cost of equipment and disposables. The primary motivators for spine surgeons' desire to implement were personal interest and patient demand. 2020 Journal of Spine Surgery. All rights reserved.
Entities:
Keywords:
Lumbar minimally invasive spinal surgery; motivators; obstacles to implementation
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