title: Surgeons agree to disagree on surgical options for degenerative conditions of the cervical and lumbar spine.
abstract: METHODS
  This is a survey study designed to evaluate agreement among spine surgeons regarding treatment options for six clinical scenarios involving degenerative conditions of the cervical and lumbar spine.
  
  
  OBJECTIVE
  The purpose was to evaluate whether or not surgeons agree on which cases require operative intervention and what type of surgery should be performed.
  
  
  BACKGROUND
  Agreement between spine surgeons on when to operate and what procedure to perform is a subject that has received increasing attention. This is an important question in the field of spine surgery, where "gold standards" that are based on large clinical trials are relatively sparse.
  
  
  METHODS
  Six clinical vignettes were presented to 19 members of the Degenerative Spine Study Group. Each vignette was accompanied by a series of radiographs and/or magnetic resonance imagings, followed by treatment options in multiple-choice format. Two months later, the same vignettes were sent out with identical instructions except that they were now told they were treating a close family member.
  
  
  RESULTS
  More than 76% of surgeons agreed on whether or not to recommend surgical intervention for the following four cases: lumbar degenerative spondylolisthesis with stenosis, cervical herniated nucleus pulposus, lumbar spondylosis, and lumbar herniated nucleus pulposus. Two scenarios had approximately 50% surgeon agreement: cervical stenosis and lumbar spondylolysis. However, despite good inter-rater agreement about who needed surgery, there was poor agreement regarding what procedure to perform if surgery was recommended. When repeating the survey in the setting of operating on a family member, only 17 (17.7%) of 96 recommendations were changed.
  
  
  CONCLUSIONS
  Spine surgeons in this survey generally agreed on when to operate but failed to agree on what type of procedures to perform.
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. joonyunglee@hotmail.com
authors.forename: Joon Y
authors.initials: JY
authors.lastname: Lee
authors.forename: Justin B
authors.initials: JB
authors.lastname: Hohl
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Fedorka
authors.forename: Clint
authors.initials: C
authors.lastname: Devin
authors.forename: Darrel S
authors.initials: DS
authors.lastname: Brodke
authors.forename: Charles L
authors.initials: CL
authors.lastname: Branch
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
mesh_terms: D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D003625:Data Collection / Q000379:methods; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D019636:Neurodegenerative Diseases / Q000473:pathology / Q000601:surgery; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D010820:Physicians; D013122:Spinal Diseases / Q000473:pathology / Q000601:surgery*