Polytomous Rasch Analyses of Surgeons’ Decision-Making on Choice of Procedure in Endoscopic Lumbar Spinal Stenosis Decompression Surgeries
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).
Clique para ver a prévia do artigoComparative Analysis of Learning Curve, Complexity, Psychological Stress, and Work Relative Value Units for CPT 62380 Endoscopic Lumbar Spinal Decompression vs Traditional Lumbar Spine Surgeries: A Paired Rasch Survey Study
Background: Effective 1 January 2017, single-level endoscopic lumbar discectomy received a Category I Current Procedural Terminology (CPT) code 62380. However, no work relative value units (RVUs) are currently assigned to the procedure. An international team of endoscopic spine surgeons conducted a study, endorsed by several spine societies, analyzing the learning curve, difficulty, psychological intensity, and estimated work RVUs of endoscopic lumbar spinal decompression compared with other common lumbar spine surgeries. Methods: A survey comparing CPT 62380 to 10 other comparator CPT codes reflective of common spine surgeries was developed to assess the work RVUs in terms of learning curve, difficulty, psychological intensity, and work effort using a paired Rasch method. Results: The survey was sent to 542 spine specialists. Of 322 respondents, 150 completed the survey for a 43.1% completion rate. Rasch analysis of the submitted responses statistically corroborated common knowledge that the learning curve with lumbar endoscopic spinal surgery is steeper and more complex than with traditional translaminar lumbar decompression surgeries. It also showed that the psychological stress and mental and work effort with the lumbar endoscopic decompression surgery were perceived to be higher by responding spine surgeons compared with posterior comparator decompression and fusion surgeries and even posterior interbody and posterolateral fusion surgeries. The regression analysis of work effort vs procedural difficulty showed the real-world evaluation of the lumbar endoscopic decompression surgery described in CPT code 62380 with a calculated work RVU of 18.2464. Conclusion: The Rasch analysis suggested the valuation for the endoscopic lumbar decompression surgery should be higher than for standard lumbar surgeries: 111.1% of the laminectomy with exploration and/or decompression of spinal cord and/or cauda equina (CPT 63005), 118.71% of the laminectomy code (CPT 63047), which includes foraminotomy and facetectomy, 152.1% of the hemilaminectomy code (CPT 63030), and 259.55% of the interlaminar or interspinous process stabilization/distraction without decompression code (CPT 22869). This research methodology was endorsed by the Interamerican Society for Minimally Invasive Spine Surgery (SICCMI), the Mexican Society of Spinal Surgeons (AMCICO), the International Society For Minimally Invasive Spine Surgery (ISMISS), the Brazilian Spine Society (SBC), the Society for Minimally Invasive Spine Surgery (SMISS), the Korean Minimally Invasive Spine Surgery (KOMISS), and the International Society for the Advancement of Spine Surgery (ISASS). Clinical Relevance: This study provides an updated reimbursement recommendation for endoscopic spine surgery
Clique para ver a prévia do artigoA new era in spine surgery
We are excited to present this special edition of the Coluna/Columna Journal, dedicated exclusively to Spine Endoscopy. In recent years, significant advances in this field have revolutionized the treatment of various spinal pathologies. The endoscopic technique has emerged as a minimally invasive alternative, offering undeniable benefits to patients and opening new horizons for medical practice. Spine Endoscopy represents a paradigm shift in surgical approach. Procedures that once required large incisions and lengthy recovery times can now be performed through small access points, minimizing trauma to surrounding tissues. As a result, patients experience less postoperative pain, recover more quickly, and return to their daily activities sooner. The reduction in surgical complications, combined with shorter hospital stays, contributes to a more efficient recovery process for both patients and the healthcare system.2,3 These positive outcomes inspire us to further explore the technique’s potential and to overcome existing challenges. Another essential aspect of endoscopic surgery is its flexibility. This technique not only addresses degenerative spine conditions but also allows for personalized approaches tailored to the unique anatomical features of each patient and the complexities of individual cases.4 This special edition features a collection of unique case reports treated with endoscopic techniques, alongside crucial anatomical foundations for the safe practice of Spine Endoscopy. We believe that disseminating knowledge is vital for establishing Spine Endoscopy as a standard tool in the treatment of spinal diseases. We invite all readers to engage with this rich and inspiring content, with the hope that it will stimulate curiosity, research, and the adoption of practices that continually benefit patients. We are entering a new era in spinal surgery, marked by innovation and an unwavering commitment to excellence. May this pioneering spirit guide our journey, and together, let us build a promising future for Brazilian medicine.
Clique para ver a prévia do artigoTranspedicular endoscopic approach in high grade migrated hernia case report
As hérnias discais extrusas com alto grau de migração caudal representam um desafio cirúrgico devido à localização do fragmento extruso em uma área de difícil acesso, conhecida como “zona oculta”. As abordagens endoscópicas tradicionais, como as vias interlaminar e transforaminal, podem ser difíceis nesses casos. Este estudo tem como objetivo relatar um caso de abordagem endoscópica transpedicular no tratamento de uma hérnia discal extrusa com migração caudal de alto grau (zona 4 de Lee). Apresentamos um paciente masculino de 52 anos com dor intensa irradiada para o membro inferior direito e déficit motor. Após falha no tratamento conservador, foi realizada uma discectomia endoscópica transpedicular em L4-L5. O procedimento foi concluído com sucesso, sem complicações, resultando em alívio imediato da dor e recuperação funcional significativa, mantida durante 24 meses de seguimento. Este caso demonstra que a abordagem endoscópica transpedicular pode ser uma alternativa eficaz e segura para o tratamento de hérnias discais extrusas com alta migração caudal, desde que realizada por cirurgiões experientes e com planejamento adequado. Nível de Evidência IV; Relato de Caso.
Clique para ver a prévia do artigoTransiliac endoscopic access for transforaminal approach at l5 s1 cases report
A cirurgia endoscópica é eficaz no tratamento de patologias foraminais da coluna vertebral, porém o acesso transforaminal em L5-S1 pode ser desafiador em pacientes com crista ilíaca alta, que dificulta ou impede o acesso suprailíaco. Neste contexto, o acesso transilíaco surge como alternativa viável. Relatamos dois casos de pacientes com hérnia discal foraminal/extraforaminal em L5-S1 e crista ilíaca alta, submetidos à discectomia endoscópica transilíaca. Ambos apresentaram melhora significativa na intensidade da dor e na incapacidade funcional, sem complicações ou queixas adicionais relacionadas à perfuração do ilíaco. Os resultados sugerem que a abordagem endoscópica transilíaca é uma opção segura e eficaz para o tratamento de patologias foraminais e extraforaminais em L5-S1 em pacientes com crista ilíaca alta. Estudos adicionais com maior número de casos são necessários para confirmar estes achados e estabelecer diretrizes para sua aplicação. Nível de Evidência IV; Relato de Caso
Clique para ver a prévia do artigoIntervertebral foramen anatomy of the lumbar spine an overview
Nas últimas décadas, as cirurgias endoscópicas minimamente invasivas da coluna vertebral avançaram significativamente, permitindo intervenções eficazes com menor trauma ao paciente. A abordagem transforaminal lombar, que utiliza o triângulo de Kambin como referência anatômica, destaca-se pela sua relevância clínica. Este artigo revisa a anatomia do forame intervertebral lombar, enfatizando variações anatômicas cruciais para a segurança e eficácia da abordagem transforaminal em cirurgias endoscópicas da coluna. O conhecimento detalhado da anatomia foraminal e das estruturas adjacentes é essencial para o planejamento cirúrgico, permitindo acesso seguro e minimizando complicações neurológicas. Nível de Evidência IV; Relato de Caso.
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