Similarities and differences in the treatment of spine trauma between surgical specialties and location of practice.
METHODS
Questionnaires administered to practicing orthopedic and neurosurgical spine surgeons from various regions of the United States and abroad.


OBJECTIVE
To determine similarities and differences in the treatment of spinal trauma.


BACKGROUND
Spinal trauma is generally referred to subspecialists of orthopedic or neurosurgical training. Prior studies have suggested that there is significant variability in the management of such injuries.


METHODS
Questionnaires based on eight clinical scenarios of commonly encountered cervical, thoracic, and lumbar injuries were administered to 35 experienced spinal surgeons. Surgeons completed profile information and answered approximately one dozen questions for each case. Data were analyzed with SPSS software to determine the levels of agreement and characteristics of respondents that might account for a lack of agreement on particular aspects of management.


RESULTS
Of the 35 surgeons completing the questionnaire, 63% were orthopedists, 37% were neurosurgeons, and 80% had been in practice for more than 5 years. Considerable agreement was found in the majority of clinical decisions, including whether or not to operate and the timing of surgery. Of the differences noted, neurosurgeons were more likely to obtain a MRI, and orthopedists were more likely to use autograft as a sole graft material. Physicians from abroad were, in general, more likely to operate and to use an anterior approach during surgery than physicians from the northeastern United States.


CONCLUSIONS
More commonalities were identified in the management of spinal trauma than previously reported. When found, variability in opinion was related to professional and regional differences.
Grauer
Jonathan N
JN
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06520-8071, USA. jonathan.grauer@yale.edu
Vaccaro
Alexander R
AR
Beiner
John M
JM
Kwon
Brian K
BK
Hilibrand
Alan S
AS
Harrop
James S
JS
Anderson
Greg
G
Hurlbert
John
J
Fehlings
Michael G
MG
Ludwig
Steve C
SC
Hedlund
Rune
R
Arnold
Paul M
PM
Bono
Christopher M
CM
Brodke
Darrel S
DS
Dvorak
Marcel F S
MF
Fischer
Charles G
CG
Sledge
John B
JB
Shaffrey
Christopher I
CI
Schwartz
David G
DG
Sears
William R
WR
Dickman
Curtis
C
Sharan
Alok
A
Albert
Todd J
TJ
Rechtine
Glenn R
GR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001208:Asia; D001315:Australia; D001915:Braces; D002170:Canada; D003657:Decision Making; D005060:Europe; D006801:Humans; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000193:education; D009985:Orthopedics / Q000193:education; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016103:Spinal Fractures / Q000601:surgery / Q000628:therapy; D013124:Spinal Injuries / Q000601:surgery / Q000628:therapy*; D011795:Surveys and Questionnaires; D014481:United States