Surgical Resident Education in Noninstrumented Lumbar Spine Surgery: A Prospective Observational Study with a 4.5-Year Follow-Up

Abstract

To review the outcomes of noninstrumented lumbar spine surgery performed by trainees as primary operators versus the outcomes of surgery performed by board-certified faculty neurosurgeons. This prospective observational study involved patients undergoing noninstrumented surgery for lumbar disc herniation or lumbar spinal stenosis with a 4.5-year follow-up. Teaching cases (patients were operated on by neurosurgical residents in training) and nonteaching cases (patients were operated on by board-certified faculty neurosurgeons) were reviewed. Back and leg pain on a visual analog scale, functional disability using the Roland Morris Disability Questionnaire and Oswestry Disability Index, and health-related quality of life (HRQOL) using the 12-Item Short Form Survey and EuroQol 5D were assessed, and reoperations since the index surgery were recorded. Questionnaires were returned by 30 patients operated on by residents and 74 patients operated on by board-certified faculty neurosurgeons. On the 12-Item Short Form Survey physical component scale metric, teaching cases were 70% as likely as nonteaching cases (odds ratio = 0.70, 95% confidence interval = 0.25-1.98, P = 0.585) to achieve a favorable HRQOL response to surgery. Visual analog scale measures of back and leg pain were similar for teaching and nonteaching cases. The same was true for functional disability as measured by the Roland Morris Disability Questionnaire and Oswestry Disability Index and for HRQOL measured by the EuroQol 5D. The reoperation rate 4.5 years after the index surgery was also similar for both groups (∼ 10% for both groups). The global outcome, as measured by HRQOL response after a mean follow-up of 4.5 years, was similar for teaching and nonteaching cases. Patients from both groups scored virtually equal results on various pain, functional, and HRQOL metrics, and the reoperation rate was similar.