Article Figures & Data
Tables
- Table 1
Description of each clinical scenario and the most common combination of procedure, bone graft, and additional treatments chosen by respondents as current practice. (TLIF = transforaminal lumbar interbody fusion).
1 Scenario C6-C7 disc herniation with monoradiculopathy in a 60 year old non-smoker Current Instrumented fusion with anterior plate and screws, structural allograft, neuromonitoring, and hard collar 2 Scenario C6-C7 disc herniation with monoradiculopathy in a 50 year old smoker with active worker's compensation claim Current Instrumented fusion with anterior plate and screws, structural allograft, neuromonitoring, and hard collar 3 Scenario C5-6, C6-C7 disc herniation with monoradiculopathy in a 60 year old non-smoker Current Instrumented fusion with anterior plate and screws, structural allograft, neuromonitoring, and hard collar 4 Scenario C4-C5, C5-C6, C6-C7 disc herniation with monoradiculopathy in a 50 year old smoker with active worker's compensation claim Current Instrumented fusion with anterior plate and screws, structural allograft, neuromonitoring, and hard collar 5 Scenario C3-C4, C4-C5, C5-C6, C6-C7 disc herniation with cervical spondylotic myelopathy in a 70 year old Current Instrumented fusion with lateral mass screws, iliac crest autograft, allograft demineralized bone matrix, neuromonitoring, and hard collar 6 Scenario L3-L4 isthmic spondylolisthesis with symptomatic radiculopathy in a 50 year old non-smoker Current Instrumented fusion with pedicle screws and rods, TLIF device, neuromonitoring; no consensus on bone graft 7 Scenario L4-L5 degenerative spondylolisthesis with neurogenic claudication in a 50 year old non-smoker Current Instrumented fusion with pedicle screws and rods, TLIF device, neuromonitoring; no consensus on bone graft 8 Scenario L2-L5 degenerative 40-degree scoliosis with 3 mm L3-L4 and L4-L5 lateral listhesis and neurogenic claudication in a 50 year old non-smoker Current Instrumented fusion with pedicle screws and rods, allograft demineralized bone matrix, neuromonitoring, cell saver n % Specialty Orthopaedic Surgery 24 60% Neurosurgery 16 40% Practice type Academic 31 78% Private Practice 9 23% Work experience 1-5 years 8 20% 5-10 years 9 23% 10-15 years 10 25% >15 years 13 33% - Table 3
Proportion of respondents for each scenario who chose uninstrumented surgery (no implants), autologous iliac crest bone graft (for fusion surgery), neuromonitoring, and hard collar or lumbosacral orthosis (LSO) for fusion surgery. (ICBG = iliac crest bone graft).
Uninstrumented ICBG Neuromonitoring Brace Case Current Bundled p Current Bundled p Current Bundled p Current Bundled p 1 13% 23% 0.24 3% 17% 0.06 63% 29% 0.002 49% 28% 0.07 2 15% 25% 0.26 20% 41% 0.07 63% 32% 0.004 50% 34% 0.23 3 3% 3% 1.0 3% 20% 0.03 66% 46% 0.08 50% 43% 0.50 4 10% 10% 1.0 19% 32% 0.18 61% 39% 0.05 54% 51% 0.82 5 20% 27% 0.43 27% 37% 0.42 73% 68% 0.62 55% 50% 0.72 6 0% 2% 1.0 22% 41% 0.06 56% 39% 0.12 29% 24% 0.62 7 0% 0% 1.0 20% 44% 0.02 61% 39% 0.05 27% 20% 0.43 8 0% 0% 1.0 27% 49% 0.04 68% 54% 0.17 32% 27% 0.62 - Table 4
Case 7. The highest proportion of respondents changing procedure (22%) occurred for case 7, but the changes are minor. Two respondents switched from minimally invasive to traditional pedicle screws and rods, and 8 fewer TLIF devices would be used. (TLIF = transforaminal lumbar interbody fusion).
Current Bundled Pedicle screws and rods 38 40 Minimally invasive pedicle screw system 3 1 TLIF device 28 20 Minimally invasive lateral retractor system 1 1 Cross link 1 1 Uninstrumented 0 0 - Table 5
Proportion of respondents who changed treatment choices between current practice and the bundled system. Additional treatments include neuromonitoring, cell saver, hard collar or lumbosacral orthosis, or external bone stimulator.
Case Change any aspect Change procedure Change bone graft Change additional treatments 1 46% 10% 22% 39% 2 46% 12% 23% 41% 3 37% 0% 23% 22% 4 44% 2% 16% 39% 5 24% 7% 15% 17% 6 44% 17% 27% 20% 7 44% 22% 27% 29% 8 49% 12% 39% 29%
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