Similarities and Differences in the Treatment of Spine Trauma Between Surgical Specialties and Location of Practice

Study Design. Questionnaires administered to practicing orthopedic and neurosurgical spine surgeons from various regions of the United States and abroad. Objectives. To determine similarities and differences in the treatment of spinal trauma. Summary of Background Data. Spinal trauma is generally referred to subspecialists of orthopedic or neurosurgical training. Prior studies have suggested that there is significant variability in the management of such injuries. Methods. Questionnaires based on eight clinical scenarios of commonly encountered cervical, thoracic, and lumbar injuries were administered to 35 experienced spinal surgeons. Surgeons completed profile information and answered approximately one dozen questions for each case. Data were analyzed with SPSS software to determine the levels of agreement and characteristics ofrespondents that might account for a lack of agreement on particular aspects of management. Results. Of the 35 surgeons completing the questionnaire, 63% were orthopedists, 37% were neurosurgeons, and 80% had been in practice for more than 5 years. Considerable agreement was found in the majority of clinical decisions, including whether or not to operate and the timing of surgery. Of the differences noted, neurosurgeons were more likely to obtain a MRI, and orthopedists were more likely to use autograft as a sole graft material. Physicians from abroad were, in general, more likely to operate and to use an anterior approach during surgery than physicians from the northeastern United States. Conclusions. More commonalities were identified in the management of spinal trauma than previously reported. When found, variability in opinion was related to professional and regional differences. Spine 2004;29:685–696