Surgeon training and clinical implementation of spinal endoscopy in routine practice: results of a global survey.

Autor:	Lewandrowski KU; Center for Advanced Spine Care of Southern Arizona, Surgical Institute of Tucson, Tucson, AZ, USA.; Department Neurosurgery, UNIRIO, Rio de Janeiro, Brazil., Soriano-Sánchez JA; The Spine Clinic, Neurological Center, ABC Medical Center, Mexico City, Mexico., Zhang X; Orthopaedic Surgeon, The Chinese PLA General Hospital, Beijing 100000, China., Ramírez León JF; Orthopedic & Minimally Invasive Spine Surgeon, Reina Sofía Clinic & Center of Minimally Invasive Spine Surgery, Bogotá, D.C., Colombia.; Spine Surgery Program, Universidad Sanitas, Bogotá, D.C., Colombia., Soriano Solis S; ABC Medical Center, Campus Santa Fe, Mexico City, Mexico., Rugeles Ortíz JG; Universidad Sanitas, Bogotá, D.C., Colombia., Alonso Cuéllar GO; Center of Minimally Invasive Spine Surgery, Bogotá, D.C., Colombia., de Lima E Silva MS; CLINCOL (Endoscopic Spine Clinic), Belo Horizonte, Minas Gerais, Brazil., Hellinger S; Isar Medizin Zentrum, 80331 München, Germany., Dowling Á; Orthopaedic Spine Surgeon, Endoscopic Spine Clinic, Santiago, Chile.; Department of Orthopaedic Surgery, USP, Ribeirão Preto, Brazil., Prada N; Orthopaedic Spine Surgeon, Foscal Internacional Clinic, Bucaramanga, Colombia., Choi G; Orthopaedic Surgeon, Gun Hospital, Pohang, Korea., Datar G; Orthopaedic Surgeon, Center for Endoscopic Spine Surgery, Sushruta Hospital for Orthopaedics & Traumatology, Miraj, Sangli, Maharashtra, India., Yeung A; University of New Mexico School of Medicine, Albuquerque, NM, USA.; Desert Institute for Spine Care, Phoenix, AZ, USA.
Jazyk:	angličtina
Zdroj:	Journal of spine surgery (Hong Kong) [J Spine Surg] 2020 Jan; Vol. 6 (Suppl 1), pp. S237-S248.
DOI:	10.21037/jss.2019.09.32
Abstrakt:	Background: Training of spine surgeons may impact the availability of contemporary minimally invasive spinal surgery (MIS) to patients and drive spine surgeons' clinical decision-making when applying minimally invasive spinal surgery techniques (MISST) to the treatment of common degenerative conditions of the lumbar spine. Training requirements and implementation of privileges vary in different parts of the world. The purpose of this study was to analyze the training in relation to practice patterns of surgeons who perform lumbar endoscopic spinal surgery the world over. Methods: The authors solicited responses to an online survey sent to spine surgeons by email, and chat groups in social media networks including Facebook, WeChat, WhatsApp, and Linkedin. Surgeons were asked the following questions: (I) please indicate your training? (II) What type of MISST spinal surgery do you perform? (III) How would you rate your experience in MIS lumbar spinal surgery and what percentage of your practice is MISST? And (IV) which avenue did you use to train for the MISST you currently employ in your clinical practice today? Descriptive statistics were applied to count responses and cross-tabulated them to the surgeon's training. Pearson Chi-square measures, kappa statistics, and linear regression analysis of agreement or disagreement were performed by analyzing the distribution of variances using statistical package SPSS version 25.0. Results: A total of 430 surgeons accessed the survey. The completion rate was 67.4%. Analyzing the responses of 292 surveys submitted by 97 neurosurgeons (33.2%), 161 orthopaedic surgeons (55.1%), and 34 surgeons of other postgraduate training (11.6%) showed that only 14% (41/292) of surgeons had completed a fellowship. Surgeons rated their skill level 33.5% of the time as master and experienced surgeon, and 35.6% of the time as novice or surgeon with some experience. There were more master (64.6% versus 29.2%) and experienced (52% versus 40%) surgeons amongst orthopaedic surgeons than amongst neurosurgeons at a statistically significant level (P=0.11). There were near twice as many orthopaedic surgeons (54.3%) using endoscopic procedures in the lumbar spine as their favorite MISST than neurosurgeons (35.4%; P=0.096). Endoscopic spine surgeons' main sources of knowledge acquisition were (I) learning in small meetings (57.3%), (II) attending workshops (63.1%), and (III) national and international conferences (59.8%). Conclusions: The majority of spine surgeons reported more than half of their cases employing MISST at a high skill level. Very few MISST surgeons are fellowship trained but attend workshops and various meetings suggesting that many of them are self-thought. Orthopaedic surgeons were more likely to implement endoscopic spinal surgery into the routine clinical practice. As endoscopic spine surgery gains more traction and patient demand, minimal adequate training will be part of the ongoing debate. Competing Interests: Conflicts of Interest: The first author has no direct or indirect conflicts. This manuscript is not meant for or intended to endorse any products or push any other agenda other than the associated clinical outcomes with endoscopic spine surgery. The motive for compiling this clinically relevant information is by no means created and/or correlated to directly enrich anyone due to its publication. This publication was intended to substantiate contemporary endoscopic spinal surgery concepts to facilitate technology advancements. Jorge Felipe Ramírez León is shareholder & President of Board of Directors Ortomac, Colombia, consultant Elliquence, USA. The senior author designed and trademarked his inside-out YESS™ technique and receives royalties from the sale of his inventions. Indirect conflicts of interest (honoraria, consultancies to sponsoring organizations are donated to IITS.org, a 501c 3 organization). (2020 Journal of Spine Surgery. All rights reserved.)
Databáze:	MEDLINE
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