Abstract
Background The authors conducted a comprehensive review and integration of insights from 4 webinars hosted by the International Society for the Advancement of Spine Surgery (ISASS) to arrive at recommendations for best clinical practices for guideline development for endoscopic spine surgery. This perspective article discusses the limitations of traditional surgical trials and amalgamates surgeons’ experience and research on various cutting-edge techniques.
Methods Data were extracted from surveys conducted during each webinar session involving 3639 surgeons globally. The polytomous Rasch model was employed to analyze responses, ensuring a robust statistical assessment of surgeon endorsements and educational impacts and focusing on operative nuances and experience-based outcomes. Bias detection was performed using the differential item functioning test.
Results The ISASS webinars provided a dynamic platform for discussing advances in endoscopic spine surgery, identifying a range of high-value procedures from basic discectomies to complex lumbar interbody fusions. Each high-value endoscopic spine surgery was highlighted in separate peer-reviewed publications, which form the basis for this summary document that synthesizes key takeaways from these webinars. High-value clinical applications of endoscopic spine surgery, primarily defined as higher-intensity endorsement transformation from the pre- to postwebinar survey with a shift to higher mean logit locations of test items both with unbiased and orderly threshold progression, were: (a) Percutaneous interlaminar endoscopic decompression for lateral canal stenosis, (b) transforaminal debridement of low-grade degenerative spondylolisthesis, (c) transforaminal full-endoscopic interbody fusion for hard disc herniation, (d) endoscopic standalone lumbar interbody fusion, (e) endoscopic debridement of spondylolytic spondylolisthesis, and (f) posterior cervical foraminotomy for herniated disc and bony stenosis.
Conclusions The ISASS webinar series has significantly impacted surgeons’ education and contributed to the identification of high-value endoscopic spine surgery practices that may serve as a cornerstone for surgeon training standards, policy, and guidelines development. Ongoing research on technological advancements and expansions of clinical indications combined with systematic review is expected to refine the recommendations on high-value endoscopic spinal surgeries recommended for enhanced reimbursement.
Clinical Relevance Assessing surgeon confidence and acceptance of endoscopic spinal surgeries using polytomous Rasch analysis.
Level of Evidence Level 2 (inferential) and 3 (observational) evidence because Rasch analysis provides statistical validation of instruments rather than direct clinical outcomes.
- endoscopic spine surgery
- clinical guidelines development
- Rasch analysis
- surgeon experience
- high-value surgical procedures
- bias detection
- surgical trial limitations
Footnotes
↵† International Society for the Advancement of Spine Surgery, e Interamerican Society for Minimally Invasive Spine Surgery - La Sociedad Interamericana de Cirugía de Columna Mínimamente Invasiva (SICCMI), International Intradisccal Therapy Society (IITS.org), National Academy of Medicine of Colombia and Brazil
↵‡ Minimally Invasive Spine Surgery Section of the Chinese Orthopedic Association (COA), International Society for Endoscopic Spine Surgery (ISESS)
↵§ Minimally Invasive Spine Surgery Section of the Chinese Orthopedic Association (COA)
↵¶ Interamerican Society for Minimally Invasive Spine Surgery - La Sociedad Interamericana de Cirugía de Columna Mínimamente Invasiva (SICCMI)
↵** Interamerican Society for Minimally Invasive Spine Surgery - La Sociedad Interamericana de Cirugía de Columna Mínimamente Invasiva (SICCMI)
↵†† International Society for Minimal Intervention in Spinal Surgery (ISMISS)
↵‡‡ Interamerican Society for Minimally Invasive Spine Surgery - La Sociedad Interamericana de Cirugía de Columna Mínimamente Invasiva (SICCMI)
↵§§ Korean Minimally Invasive Spine Society
↵¶¶ Interamerican Society for Minimally Invasive Spine Surgery - La Sociedad Interamericana de Cirugía de Columna Mínimamente Invasiva (SICCMI)
↵*** International Society for Minimal Intervention in Spinal Surgery (ISMISS)
↵††† International Society for Minimal Intervention in Spinal Surgery (ISMISS)
↵‡‡‡ Brazilian Society for Thoracic Surgery – Sociedade Brasileira de Cirurgia Torácica (SBCT)
↵§§§ International Society for the Advancement of Spine Surgery
Funding ISASS received funding for the webinar series upon which this article is based as well as for the publication of this special issue. Funding was paid directly to the organization. No formal funding by private, government or commercial funders was received by the authors.
Declaration of Conflicting Interests The authors volunteered their time and internal resources to support the design and conduction of this research study. All authors aided in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. The authors declare no conflict of interest relevant to this research, and there was no personal circumstance or interest that may be perceived as inappropriately influencing the representation or interpretation of reported research results. This research was not compiled to enrich anyone.
Disclosures Brian Kwon reports royalties for product design from Globus/NUVA; consulting fees from Globus/NUVA for evaluation of products and technology; payment/honoraria for surgeon education/training from Globus/NUVA and Amplify Surgical; and stock/stock options in Amplify Surgical and SAB. Choll Kim reports consulting fees from Elliquence and Globus Medical. Gregory Basil reports consulting fees from Nuvasive, DePuy Synthes, and Aclarion; ownership and patents planned, issued, or pending with Kinesiometrics; and participation on a data safety monitoring board or advisory board for Hart Clinical Consultants. Christian Morgenstern reports royalties/licenses with Signus GmbH and Hoogland Spine Products GmbH; consulting fees from SpineArt SA and UniTech GmbH; and support for attending meetings and/or travel from Hoogland Spine GmbH and Signus GmbH. Jin-Sung Kim reports serving as a consultant for RIWOSpine GmbH and Elliquence; serving on the AOSpine Task Force, AOSpine Degenerative Knowledge Forum, and NASS Endoscopy Task Force; and stock/stock options from Amplify Surgical. Jorge Felipe Ramírez León reports grants/contracts, consulting fees, and payment/honoraria from Elliquence.
- This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2024 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.
In this issue
Jump to section
- Article
- Abstract
- Introduction
- Clinical Trial Limitations
- Traditional Workarounds
- Evidence-Based Medicine and Guideline Development
- Living Clinical Guideline
- The Alternative Approach—Tapping Directly into Spine Surgeons’ Clinical Experience
- Rasch Methodology to Filter Out High-Value Endoscopic Surgeries
- Sample Size
- Bias Detection
- Criteria for Identification of High-Value Surgeries
- High-Value Endoscopic Spine Surgeries
- Discussion
- Conclusion
- Acknowledgments
- Footnotes
- References
- Figures & Data
- Info & Metrics
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