title: Survey of French spine surgeons reveals significant variability in spine trauma practices in 2013.
abstract: BACKGROUND
  In France, attempts to define common ground during spine surgery meetings have revealed significant variability in clinical practices across different schools of surgery and the two specialities involved in spine surgery, namely, neurosurgery and orthopaedic surgery.
  
  
  OBJECTIVE
  To objectively characterise this variability by performing a survey based on a fictitious spine trauma case. Our working hypothesis was that significant variability existed in trauma practices and that this variability was related to a lack of strong scientific evidence in spine trauma care.
  
  
  METHODS
  We performed a cross-sectional survey based on a clinical vignette describing a 31-year-old male with an L1 burst fracture and neurologic symptoms (numbness). Surgeons received the vignette and a 14-item questionnaire on the management of this patient. For each question, surgeons had to choose among five possible answers. Differences in answers across surgeons were assessed using the Index of Qualitative Variability (IQV), in which 0 indicates no variability and 1 maximal variability. Surgeons also received a questionnaire about their demographics and surgical experience.
  
  
  RESULTS
  Of 405 invited spine surgeons, 200 responded to the survey. Five questions had an IQV greater than 0.9, seven an IQV between 0.5 and 0.9, and two an IQV lower than 0.5. Variability was greatest about the need for MRI (IQV=0.93), degree of urgency (IQV=0.93), need for fusion (IQV=0.92), need for post-operative bracing (IQV=0.91), and routine removal of instrumentation (IQV=0.94). Variability was lowest for questions about the need for surgery (IQV=0.42) and use of the posterior approach (IQV=0.36). Answers were influenced by surgeon specialty, age, experience level, and type of centre.
  
  
  CONCLUSIONS
  Clinical practice regarding spine trauma varies widely in France. Little published evidence is available on which to base recommendations that would diminish this variability.
authors.affiliation: Service de chirurgie orthopédique, hôpital Raymond-Poincaré, 104, avenue Raymond-Poincaré, 92380 Garches, France. Electronic address: dr.guillaume.lonjon@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Lonjon
authors.affiliation: Service de neurochirurgie, CHU Dijon, 21079 Dijon, France.
authors.forename: M
authors.initials: M
authors.lastname: Grelat
authors.affiliation: Service de chirurgie orthopédique, hôpital Carremau, CHU Nimes, 30000 Nimes, France.
authors.forename: A
authors.initials: A
authors.lastname: Dhenin
authors.affiliation: Service de chirurgie orthopédique, hôpital Beaujon, 100, avenue du Général-Leclerc, 92210 Clichy, France.
authors.forename: C
authors.initials: C
authors.lastname: Dauzac
authors.affiliation: Service de neurochirurgie, hôpital Guy-de-Chauliac, 34090 Montpellier, France.
authors.forename: N
authors.initials: N
authors.lastname: Lonjon
authors.affiliation: 925 Chesnut Street, 5th Floor, Philadelphia, PA 19107, USA.
authors.forename: C K
authors.initials: CK
authors.lastname: Kepler
authors.affiliation: 925 Chesnut Street, 5th Floor, Philadelphia, PA 19107, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Vaccaro
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D005602:France; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011365:Professional Practice Location; D013043:Specialties, Surgical; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion; D066231:Surgeons; D011795:Surveys and Questionnaires
keywords: Spine surgery; Spine trauma; Surgical decision making