Data from: Clinical decision making in spinal fusion for chronic low back pain. Results of a nationwide survey among spine surgeons

OBJECTIVES: To assess the use of prognostic patient factors and predictive tests in clinical decision making for spinal fusion in patients with chronic low back pain. DESIGN AND SETTING: Nationwide survey among spine surgeons. PARTICIPANTS: Surgeon members of the Dutch Spine Society were questioned on their treatment strategy for chronic low back pain. PRIMARY AND SECONDARY OUTCOME MEASURES: The surgeons’ opinion on the use of prognostic factors and tests for patient selection were addressed, and the degree of uniformity was assessed. In addition, the influence of surgeon specific factors, such as clinical experience and training, was determined. RESULTS: The comments from 62 surgeons (70% response rate) were analysed. Forty-four surgeons (71%) had extensive clinical experience. There was a statistically significant lack of uniformity of opinion in 7 of the 11 items on prognostic factors and 8 of the 11 items on predictive tests, respectively. Imaging was valued much higher than predictive tests, psychological screening, or patient preferences (all p<0.01). Apart from the use of discography and long multi-segment fusions, differences in training or clinical experience did not appear to be of significant influence on treatment strategy. CONCLUSIONS: The present survey showed a lack of consensus among spine surgeons on the use of predictive tests for patient selection. Prognostic patient factors were not consistently incorporated in their treatment strategy. Clinical decision making for spinal fusion to treat chronic low back pain does not have a uniform evidence base in practice. Future research should focus on identifying subgroups of patients for whom spinal fusion is an effective treatment. Only a reliable prediction of surgical outcome, combined with the implementation of individual patient factors, may enable the instalment of consensus guidelines in surgical decision making for chronic low back pain.

研究目的：评估慢性下腰痛（chronic low back pain）患者脊柱融合术（spinal fusion）临床决策中预后性患者因素（prognostic patient factors）与预测性检测（predictive tests）的应用情况。
研究设计与实施场景：针对脊柱外科医师（spine surgeons）开展的全国性调查。
研究对象：调研荷兰脊柱学会（Dutch Spine Society）的外科医师会员，询问其针对慢性下腰痛的临床治疗策略。
主要与次要结局指标：调研外科医师在患者遴选时对预后因素与检测手段的使用意见，并评估其诊疗意见的一致性程度；同时明确医师个体特征（如临床经验、受训背景）对治疗决策的影响。
研究结果：本研究共纳入62份有效反馈（应答率70%）并进行分析，其中44名医师（占比71%）具备丰富的临床经验。在11项预后因素相关调研条目与11项预测性检测相关调研条目中，分别有7项与8项存在统计学意义上的意见不统一情况。影像学检查的受重视程度远高于预测性检测、心理筛查或患者自身意愿（所有指标均p<0.01）。除椎间盘造影术（discography）与长节段融合术（multi-segment fusions）的应用差异外，受训背景或临床经验的差异并未对治疗策略产生显著影响。
研究结论：本次调查显示，脊柱外科医师在患者遴选时预测性检测手段的使用方面尚未达成共识。预后性患者因素并未被统一纳入其临床治疗决策流程。用于治疗慢性下腰痛的脊柱融合术临床决策，在临床实践中尚未形成统一的循证依据。未来研究应聚焦于明确脊柱融合术有效的患者亚群（subgroups of patients）。唯有通过可靠的手术结局（surgical outcome）预测，并结合个体化患者因素，方能为慢性下腰痛的手术决策确立共识指南。