What if You Could Treat the Same Patient Again, Would You do the Exact Same Spine Surgery? A Multi-Surgeon Survey of Their Own Revisions.

Abstract

Case-based survey. This study aims to investigate what a group of surgeons learned from their own revisions, and what they would do differently today. A multi-center database of ASD surgical patients was queried to identify those with at least 2 surgical procedures performed by the same surgeon between 2009 and 2019. A clinical vignette was created for each case including demographics, a timeline of events, radiographs/measurements, patient-reported outcomes, complications, and surgical strategies used for the index and revision surgeries. The operative surgeon was then asked to fill out a five-question survey aimed at determining factors that contribute to operative decision-making and planning. 86 patients were operated on by 6 participating surgeons for both index and revision ASD surgery. The revised patients had similar follow-up compared to the non-revised group (P = 0.73), with the most common complications indicating a need for revision surgery being proximal junctional failure (42%) and pseudoarthrosis (28%). Surgeons reported that they would not change their surgical strategy in 52.3% of the cases. The leading cause for revision was hardware/instrumentation issues (24.4%). Learning points included rod-related choice (23.3%), level selection (19.8), PJF prophylactic strategy (15.1%), and sagittal alignment objective (11.6%). Surgeons saw opportunity in nearly half of the cases to improve outcomes by changing something in the original surgery. While 40% of the failures remained unexplained from the surgeons' perspective, this study highlights the capacity for adopting changes in adult spinal deformity surgery and illuminates the reasoning behind certain surgical decisions.