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Current patterns of practice in spinal fusion for chronic low back pain—results from a survey at the German Spine Societies’ Annual Congress 2018

  • Original Article - Spine degenerative
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Abstract

Background

There is debate regarding criteria to select patients for lumbar fusion surgery who have chronic low back pain (CLBP) and corresponding degenerative changes, but without nerve root compression or neurogenic claudication. The aim of this study was to compare patterns in current practice.

Method

A total of 143 printed questionnaires containing 51 questions were distributed at the German Spine Societies' (DWG) annual congress, 6–8 December 2018.

Results

We received 127 (89%) surveys (64 orthopedic surgeons and 63 neurosurgeons). Excluding the 22% who do not perform lumbar fusion for CLBP, 41.4% reported performing 1–10 lumbar fusion procedures for patients with CLBP per year, 20.2% reported 11–20, 10.1% reported 21–30 and 17.2% reported performing more than 50. A total of 44.9% of surgeons reported treating patients for at least 6–12 months conservatively before considering surgery; 65.6% considered postoperative pain reduction of 50–70% a treatment success; 32.6% of respondents believe that <50% of patients showed good outcomes after fusion in CLBP and only 15.5% believed that 70% or more showed good outcomes. Orthopedic surgeons perform more lumbar fusion surgeries than neurosurgeons (p = 0.05), fuse more lumbar segments than neurosurgeons (p = 0.02) and are more likely to suggest that their patients with CLBP cease smoking preoperatively (p = 0.02).

Conclusions

Despite discouraging evidence in the literature, the majority of respondents still perform fusion surgery in patients with CLBP. The use of preoperative diagnostics and tests vary widely among spine surgeons.

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References

  1. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G, Pain CBWGGCLB (2006) Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 15(Suppl 2):S192–S300. https://doi.org/10.1007/s00586-006-1072-1

    Article  PubMed  PubMed Central  Google Scholar 

  2. Brox JI, Nygaard OP, Holm I, Keller A, Ingebrigtsen T, Reikeras O (2010) Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain. Ann Rheum Dis 69:1643–1648. https://doi.org/10.1136/ard.2009.108902

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chenot JF, Greitemann B, Kladny B, Petzke F, Pfingsten M, Schorr SG (2017) Non-Specific Low Back Pain. Dtsch Arztebl Int 114:883–890. https://doi.org/10.3238/arztebl.2017.0883

    Article  PubMed  PubMed Central  Google Scholar 

  4. Datta S, Lee M, Falco FJ, Bryce DA, Hayek SM (2009) Systematic assessment of diagnostic accuracy and therapeutic utility of lumbar facet joint interventions. Pain Phys 12:437–460

    Google Scholar 

  5. Deyo RA, Bass JE (1989) Lifestyle and low-back pain. The influence of smoking and obesity. Spine (Phila Pa 1976) 14:501–506. https://doi.org/10.1097/00007632-198905000-00005

    Article  CAS  Google Scholar 

  6. Fairbank J, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R, Spine Stabilisation Trial G (2005) Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ 330:1233. https://doi.org/10.1136/bmj.38441.620417.8F

    Article  PubMed  PubMed Central  Google Scholar 

  7. Fritzell P, Hagg O, Jonsson D, Nordwall A, Swedish Lumbar Spine Study G (2004) Cost-effectiveness of lumbar fusion and nonsurgical treatment for chronic low back pain in the Swedish Lumbar Spine Study: a multicenter, randomized, controlled trial from the Swedish Lumbar Spine Study Group. Spine (Phila Pa 1976) 29:421–434; discussion Z423. https://doi.org/10.1097/01.brs.0000102681.61791.12

    Article  Google Scholar 

  8. Fritzell P, Hagg O, Wessberg P, Nordwall A, Swedish Lumbar Spine Study G (2001) 2001 Volvo Award Winner in Clinical Studies: lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine (Phila Pa 1976) 26:2521–2532; discussion 2532-2524. https://doi.org/10.1097/00007632-200112010-00002

    Article  CAS  Google Scholar 

  9. Low back pain and sciatica in over 16s: assessment and management, NICE guideline [NG59] (2016) National Institute for Health and Care Excellence (NICE), https://www.nice.org.uk/guidance/ng59. Accessed 06 Jan 2021

  10. Martin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS (2019) Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015. Spine (Phila Pa 1976) 44:369–376. https://doi.org/10.1097/BRS.0000000000002822

    Article  Google Scholar 

  11. Ohtori S, Koshi T, Yamashita M, Yamauchi K, Inoue G, Suzuki M, Orita S, Eguchi Y, Ochiai N, Kishida S, Takaso M, Kuniyoshi K, Aoki Y, Ishikawa T, Arai G, Miyagi M, Kamoda H, Suzuki M, Nakamura J, Toyone T, Takahashi K (2011) Surgical versus nonsurgical treatment of selected patients with discogenic low back pain: a small-sized randomized trial. Spine (Phila Pa 1976) 36:347–354. https://doi.org/10.1097/BRS.0b013e3181d0c944

    Article  Google Scholar 

  12. Staal JB, de Bie RA, de Vet HC, Hildebrandt J, Nelemans P (2009) Injection therapy for subacute and chronic low back pain: an updated Cochrane review. Spine (Phila Pa 1976) 34:49–59. https://doi.org/10.1097/BRS.0b013e3181909558

    Article  Google Scholar 

  13. Todd NV (2017) The surgical treatment of non-specific low back pain. Bone Joint J 99-B:1003–1005. https://doi.org/10.1302/0301-620X.99B8.BJJ-2017-0199.R1

    Article  CAS  PubMed  Google Scholar 

  14. van Tulder MW, Assendelft WJ, Koes BW, Bouter LM (1997) Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies. Spine (Phila Pa 1976) 22:427–434. https://doi.org/10.1097/00007632-199702150-00015

    Article  Google Scholar 

  15. Watters WC 3rd, Resnick DK, Eck JC, Ghogawala Z, Mummaneni PV, Dailey AT, Choudhri TF, Sharan A, Groff MW, Wang JC, Dhall SS, Kaiser MG (2014) Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 13: injection therapies, low-back pain, and lumbar fusion. J Neurosurg Spine 21:79–90. https://doi.org/10.3171/2014.4.SPINE14281

    Article  PubMed  Google Scholar 

  16. Willems P (2013) Decision making in surgical treatment of chronic low back pain: the performance of prognostic tests to select patients for lumbar spinal fusion. Acta Orthop Suppl 84:1–35. https://doi.org/10.3109/17453674.2012.753565

    Article  PubMed  Google Scholar 

  17. Willems P, de Bie R, Oner C, Castelein R, de Kleuver M (2011) Clinical decision making in spinal fusion for chronic low back pain. Results of a nationwide survey among spine surgeons. BMJ Open 1:e000391. https://doi.org/10.1136/bmjopen-2011-000391

    Article  PubMed  PubMed Central  Google Scholar 

  18. Willems PC, Staal JB, Walenkamp GH, de Bie RA (2013) Spinal fusion for chronic low back pain: systematic review on the accuracy of tests for patient selection. Spine J 13:99–109. https://doi.org/10.1016/j.spinee.2012.10.001

    Article  PubMed  Google Scholar 

  19. Wilson-MacDonald J, Fairbank J, Frost H, Yu LM, Barker K, Collins R, Campbell H, Spine Stabilization Trial G (2008) The MRC spine stabilization trial: surgical methods, outcomes, costs, and complications of surgical stabilization. Spine (Phila Pa 1976) 33:2334–2340. https://doi.org/10.1097/BRS.0b013e318186a8b2

    Article  Google Scholar 

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Acknowledgements

We would like to thank Max Joseph Scheyerer for proofreading the questionnaire

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland

    Dominik Baschera & Alex Alfieri

  2. Department of Neurosurgery, Luzerner Kantonsspital, Spitalstrasse, 6004, Luzern, Switzerland

    Dominik Baschera

  3. Center of Orthopedic and Trauma Surgery, University Hospital, Kerpener Str. 62, 50937, Cologne, Germany

    Sofia Syrianos & Leonard Westermann

  4. Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Bachemer Str. 86, 50931, Cologne, Germany

    Christina Samel

  5. Brandenburg Medical School, Fehrbellinerstrasse, 38, 16816, Neuruppin, Germany

    Alex Alfieri

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  1. Dominik Baschera
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  5. Leonard Westermann
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Contributions

DB, LW, AA: study concept and design and supervision

SS, DB, LW: data collection and organization

CS, DB: data analysis and statistics

DB, LW: manuscript draft

AA: manuscript revision

Corresponding author

Correspondence to Dominik Baschera.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, no official ethics approval was necessary, and formal consent is not required. The procedures used in this study adhere to the tenets of the 1964 Declaration of Helsinki and its later amendments.

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This article is part of the Topical Collection on Spine degenerative

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Baschera, D., Syrianos, S., Samel, C. et al. Current patterns of practice in spinal fusion for chronic low back pain—results from a survey at the German Spine Societies’ Annual Congress 2018. Acta Neurochir 163, 853–861 (2021). https://doi.org/10.1007/s00701-020-04691-1

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  • DOI: https://doi.org/10.1007/s00701-020-04691-1

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