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Surgeon reported practice patterns related to full endoscopic cervical decompression procedures

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Abstract

Background

The microsurgical anterior approach to the cervical spine is commonplace. Fewer surgeons perform posterior cervical microsurgical procedures on a routine basis for lack of indication, more bleeding, persistent postoperative neck pain, and risk of progressive misalignment. In comparison, the endoscopic technique is preferentially performed through the posterior approach. Many spine surgeons and even surgeons versed in lumbar endoscopy are often reluctant to consider endoscopic procedures in the cervical spine. We report the results of a surgeon survey to find out why.

Methods

A questionnaire of 10 questions was sent to spine surgeons by email and chat groups in social media networks including Facebook, WeChat, WhatsApp, and LinkedIn to collect practice pattern data about microscopic and endoscopic spine surgery in the lumbar and cervical spine. The responses were cross-tabulated by surgeons’ demographic data. Pearson Chi-Square measures, Kappa statistics, and linear regression analysis of agreement or disagreement were performed by analyzing the distribution of variances using the statistical package SPSS Version 27.0.

Results

The survey response rate was 39.7%, with 50 of the 126 surgeons who started the survey submitting a completed questionnaire. Of the 50 surgeons, 56.2% were orthopedic, and 42% neurological surgeons. Most surgeons worked in private practice (42%). Another 26% were university-employed, 18% were in private practice affiliated with a university, and the remaining 14% were hospital employed. The majority of surgeons (55.1%) were autodidacts. The largest responding surgeon groups were between 35–44 years (38%) and between 45–54 years of age (34%). Half of the responding surgeons were routinely performing endoscopic cervical spine surgery. The other half did not perform it for the main hurdle of fear of complications (50%). Lack of appropriate mentorship was listed as second most reason (25.4%). More concerns for not performing cervical endoscopic approaches were the perception of lack of technology (20.8%) and suitable surgical indication (12.5%). Only 4.2% considered cervical endoscopy too risky. Nearly a third (30.6%) of the spine surgeons treated over 80% of their cervical spine patients with endoscopic surgeries. Most commonly performed were posterior endoscopic cervical discectomy (PECD; 52%), posterior endoscopic cervical foraminotomy (PECF; 48%), anterior endoscopic cervical discectomy (AECD; 32%), cervical endoscopic unilateral laminotomy for bilateral decompression (CE-ULBD; 30%), respectively.

Conclusion

Cervical endoscopic spine surgery is gaining traction among spine surgeons. However, by far most surgeons performing cervical endoscopic spine surgery work in private practice and are autodidacts. This lack of a teacher to shorten the learning curve as well as fear of complications are two of the major impediments to the successful implementation of cervical endoscopic procedures.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. University Spine Center Zürich, Balgrist University Hospital, Zurich, Switzerland

    Vincent Hagel

  2. Asklepios Hospital Lindau, Spine Center, Lindau, Germany

    Vincent Hagel

  3. Ligamenta Spine Center, Frankfurt Am Main, Germany

    Ralf Wagner

  4. Rhön-Klinikum, Campus Bad Neustadt, Bad Neustadt a. d. Saale, Germany

    Albrecht Waschke

  5. Department of Neurological Surgery, University of Washington, Seattle, WA, USA

    Christoph P. Hofstetter

  6. Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA

    Albert E. Telfeian

  7. enVISION Spine Surgery, New York, NY, USA

    Jian Shen

  8. Center for Advanced Spine Care of Southern Arizona, Surgical Institute of Tucson, Tucson, AZ, USA

    Kai-Uwe Lewandrowski

  9. Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá, D.C, Colombia

    Kai-Uwe Lewandrowski

  10. Department of Orthopedics at Hospital, Universitário Gaffre e Guinle, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil

    Kai-Uwe Lewandrowski

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  1. Vincent Hagel
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  2. Ralf Wagner
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  3. Albrecht Waschke
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  4. Christoph P. Hofstetter
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  5. Albert E. Telfeian
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Correspondence to Vincent Hagel.

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Hagel, V., Wagner, R., Waschke, A. et al. Surgeon reported practice patterns related to full endoscopic cervical decompression procedures. Eur Spine J 32, 2662–2669 (2023). https://doi.org/10.1007/s00586-023-07675-8

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  • DOI: https://doi.org/10.1007/s00586-023-07675-8

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