PT  - JOURNAL ARTICLE
AU  - Kai-Uwe Lewandrowski
AU  - Rossano Kepler Alvim Fiorelli
AU  - Mauricio G. Pereira
AU  - Ivo Abraham
AU  - Heber Humberto Alfaro Pachicano
AU  - John C. Elfar
AU  - Abduljabbar Alhammoud
AU  - Stefan Landgraeber
AU  - Joachim Oertel
AU  - Stefan Hellinger
AU  - Álvaro Dowling
AU  - Paulo Sérgio Teixeira De Carvalho
AU  - Max R.F Ramos
AU  - Helton Defino
AU  - João Paulo Bergamaschi
AU  - Nicola Montemurro
AU  - Christopher Yeung
AU  - Marcelo Brito
AU  - Douglas P. Beall
AU  - Gerd Ivanic
AU  - Zhang Xifeng
AU  - Zhen-Zhou Li
AU  - Jin-Sung L. Kim
AU  - Jorge F. Ramirez
AU  - Morgan P. Lorio
TI  - Polytomous Rasch Analyses of Surgeons’ Decision-Making on Choice of Procedure in Endoscopic Lumbar Spinal Stenosis Decompression Surgeries
AID  - 10.14444/8595
DP  - 2024 Apr 01
TA  - International Journal of Spine Surgery
PG  - 164--177
VI  - 18
IP  - 2
4099  - https://www.ijssurgery.com/content/18/2/164.short
4100  - https://www.ijssurgery.com/content/18/2/164.full
SO  - Int J Spine Surg2024 Apr 01; 18
AB  - Background With the growing prevalence of lumbar spinal stenosis, endoscopic surgery, which incorporates techniques such as transforaminal, interlaminar, and unilateral biportal (UBE) endoscopy, is increasingly considered. However, the patient selection criteria are debated among spine surgeons.Objective This study used a polytomous Rasch analysis to evaluate the factors influencing surgeon decision-making in selecting patients for endoscopic surgical treatment of lumbar spinal stenosis.Methods A comprehensive survey was distributed to a representative sample of 296 spine surgeons. Questions encompassed various patient-related and clinical factors, and responses were captured on a logit scale graphically displaying person-item maps and category probability curves for each test item. Using a Rasch analysis, the data were subsequently analyzed to determine the latent traits influencing decision-making.Results The Rasch analysis revealed that surgeons’ preferences for transforaminal, interlaminar, and UBE techniques were easily influenced by comfort level and experience with the endoscopic procedure and patient-related factors. Harder-to-agree items included technological aspects, favorable clinical outcomes, and postoperative functional recovery and rehabilitation. Descriptive statistics suggested interlaminar as the best endoscopic spinal stenosis decompression technique. However, logit person-item analysis integral to the Rasch methodology showed highest intensity for transforaminal followed by interlaminar endoscopic lumbar stenosis decompression. The UBE technique was the hardest to agree on with a disordered person-item analysis and thresholds in category probability curve plots.Conclusion Surgeon decision-making in selecting patients for endoscopic surgery for lumbar spinal stenosis is multifaceted. While the framework of clinical guidelines remains paramount, on-the-ground experience-based factors significantly influence surgeons’ selection of patients for endoscopic lumbar spinal stenosis surgeries. The Rasch methodology allows for a more granular psychometric evaluation of surgeon decision-making and accounts better for years-long experience that may be lost in standardized clinical guideline development. This new approach to assessing spine surgeons’ thought processes may improve the implementation of evidence-based protocol change dictated by technological advances was endorsed by the Interamerican Society for Minimally Invasive Spine Surgery (SICCMI), the International Society for Minimal Intervention in Spinal Surgery (ISMISS), the Mexican Spine Society (AMCICO), the Brazilian Spine Society (SBC), the Society for Minimally Invasive Spine Surgery (SMISS), the Korean Minimally Invasive Spine Society (KOMISS), and the International Society for the Advancement of Spine Surgery (ISASS).