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Clinicians’ perceptions around discectomy surgery for lumbar disc herniation: a survey of orthopaedic and neuro-surgeons in Australia and New Zealand

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Understanding practice-based differences in treatment of lumbar disc herniations (LDHs) is vital for reducing unwarranted variation in the delivery of spine surgical health care. Identifying factors that influence surgeons’ decision-making will offer useful insights for developing the most cost-effective and safest surgical strategy as well as developing surgeon education materials for common lumbar pathologies. This study was to capture any variation in techniques used by surgeons in Australia and New Zealand (ANZ) region, and perceived complications of different surgical procedures for primary and recurrent LDH (rLDH).

Materials and methods

Web-based survey study was emailed to orthopaedic and neurosurgeons who routinely performed spinal surgery in ANZ from Decmber 20, 2018 to February 20, 2020. The response data were analyzed to assess for differences based on geography, practice setting, speciality, practice experience, practice length, and operative volume.

Results

Invitations were sent to 150 surgeons; 96 (64%) responded. Most surgeons reported microdiscectomy as their surgical technique of choice for primary LDH (73%) and the first rLDH (72%). For the second rLDH, the preferred choice for most surgeons was fusion surgery (82%). A surgeon’s practice setting (academic/private/hybrid) was a statistically significant factor in what surgical procedure was chosen for the first rLDH (P = 0.014). When stratifying based on surgeon experience, there were statisfically significant differences based on the annual volume of spine surgeries performed (perceived reherniation rates following primary discectomy, P = 0.013; perceived reherniation rates following revision surgeries, P = 0.017; perceived intraoperative complications rates following revision surgeries, P = 0.016) and based on the annual volume of lumbar discectomies performed (perceived reherniation rates following revision surgeries, P = 0.022; perceived intraoperative complications rates following revision surgeries, P = 0.036; perceived durotomy rates following primary discectomy, P = 0.023).

Conclusions

Surgeons’ annual practice volume and practice setting have significant influences in the selection of surgical procedures and the perception of surgical complications when treating LDHs.

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Acknowledgements

The authors thank the Spine Society of Australia (SSA), Australian Orthopaedic Association (AOA), Neurosurgical Society of Australasia, New Zealand Orthopaedic Association, Neurological Association of New Zealand, and ISSLS and their members for their participation in this survey. The authors also thank Dr Ralph Stanford (Department of Orthopaedic Surgery, Prince of Wales Hospital, Sydney, Australia) for valuable feedback on improving the quality of the survey and Peter Geelan-Small (Stats Central, UNSW) for helping develop the statistical analyses plan for this survey.

Funding

This work was supported by a Research Training Program scholarship and a University Postgraduate Award from the Australian Government and UNSW to Dr Chen. A Clinical Travelling Fellowship from the International Society for the Study of the Lumbar Spine (ISSLS) in 2018 further supported this work. The Rush University provided a travelling fellowship to Dr Fogel for visiting UNSW. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Level 3, WR Pitney Building, Kogarah, Sydney, NSW, 2217, Australia

    Xiaolong Chen, Uphar Chamoli & Ashish D. Diwan

  2. School of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, Australia

    Uphar Chamoli

  3. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Harold Fogel

  4. Spine Service, Department of Orthopaedic Surgery, St. George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia

    Ashish D. Diwan

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Contributions

CC, and ADD had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: XC, UC, HF, ADD. Drafting of the manuscript: XC and UC. Critical revision of the manuscript for important intellectual content: XC, UC, HF, ADD Statistical analysis: Dr Chen. Administrative, technical, or material support: UC, HF, ADD. Supervision: HF, UC, ADD.

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Correspondence to Ashish D. Diwan.

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This study got ethics approval from the University of New South Wales—Human Research Ethics Committee (HC 180800).

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Chen, X., Chamoli, U., Fogel, H. et al. Clinicians’ perceptions around discectomy surgery for lumbar disc herniation: a survey of orthopaedic and neuro-surgeons in Australia and New Zealand. Arch Orthop Trauma Surg 143, 189–201 (2023). https://doi.org/10.1007/s00402-021-04019-3

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