Introduction: Understanding practice-based differences in the treatment of lumbar disc herniations is vital for reducing unwarranted variation in the delivery of spine surgical health care. Identifying factors that influence surgeons’ decision-making will offer useful insights for further developing the most cost-effective and safest surgical strategy as well as developing surgeon education materials for these common lumbar pathologies. The aim of this study is to capture any variation in techniques used and perceived complications of the various surgical procedures for primary and recurrent lumbar disc herniation.
Methods: Web-based survey study was emailed to surgeons affiliated with relevant societies to assess surgical techniques for discectomy and perceived complications associated with the treatment of primary and recurrent lumbar disc herniations. Participants were orthopaedic and neurosurgeons who routinely performed spinal surgery in Australia and New Zealand from Decmber 20, 2018 to February 20, 2020. Orthopaedic and neurosurgeons’ preference of treatment for primary and recurrent lumbar disc herniations and perceived complications. The response data was analyzed to assess the differences across surgeons’ demographic factors (geography, practice setting, speciality, practice experience, practice length, and operative volume).
Results: Invitations were sent to 260 surgeons; 96 (37%) responded. Most surgeons reported microdiscectomy as their surgical technique of choice for primary LDH (73%) and for the first rLDH (72%). For the second and subsequent rLDH, the preferred choice for most surgeons was fusion surgery (82%). Surgeons in different practice settings (academic/private/hybrid) demonstrated a statistically significant difference in the choice of surgical procedures for the first recurrent lumbar disc herniation (P=0.014). When stratifying based on surgeon experience, there were statisfically significant differences based on the annual volume of spine surgeries performed (perceived reherniation rates following primary discectomy, P=0.013; perceived reherniation rates following revision surgeries for rLDH, P=0.017; perceived intraoperative complications rates following revision surgeries for rLDH, P=0.016) and based on the annual volume of lumbar discectomies performed (perceived reherniation rates following revision surgeries for rLDH, P=0.022; perceived intraoperative complications rates following revision surgeries for rLDH, P=0.036; perceived durotomy rates following primary discectomy, P=0.023).
Conclusions: Surgeons’ annual practice volume and practice setting has important implications in the selection of surgical procedures and the perception of surgical complications when treating lumbar disc herniations. Recognizing the substantial variations that exist in the surgical management of primary and recurrent lumbar disc herniation will help in standardizing the protocols for effective management of this spinal condition and improve outcomes.