Spine Surgeons Burnout and Quality of Life: Results of a Worldwide Survey.

STUDY DESIGN: Cross-sectional survey study. OBJECTIVE: To evaluate the prevalence of burnout, assess the personal and professional characteristics associated with burnout in spine surgeons and determine their quality of life. SUMMARY OF BACKGROUND DATA: Burnout is a syndrome characterized by emotional exhaustion, depersonalization, and decreased sense of accomplishment that leads to decreased effectiveness at work. To date, there has been a lack of information on the prevalence of burnout among spine surgeons worldwide and the risk factors associated with this condition. METHODS: An electronic survey with members of AO Spine was performed in May 2018. The survey evaluated demographic variables, practice characteristics, burnout, and quality of life. Maslach Burnout Inventory (MBI) and EuroQol 5-dimensions (EQ5D) were used to evaluate burnout and quality of life, respectively. RESULTS: A total of 818 surgeons from 86 countries completed the survey. The prevalence of burnout was 30.6%. In the multiple linear model, emotional fatigue was independently associated with younger age (B = -0.17, CI95% = -0.26 to -0.07, P < 0.0001), and longer working hours per week (B = -2.71, CI95% = -4.34 to -1.07, P = 0.001); depersonalization was independently associated with younger age (B = -0.13, CI95% = -0.19 to -0.07, P < 0.0001), practicing outside Latin America (LA) (B = 0.71, CI95% = 0.41-1.01, P < 0.0001) and currently being a fellow (B = 0.54, CI95% = 0.06-1.02, P = 0.02); and higher scores of personal fulfilment was associated with practicing in LA (B = -1.27, CI95% = -1.69 to -0.85, P < 0.0001). CONCLUSION: Burnout is a common condition among spine surgeons worldwide. There is a significant association between burnout scores and decreased general quality of life. These results highlight the need to develop interventional programs to better identify, prevent, and manage this condition among practicing spine surgeons.Level of Evidence: 4.

Worldwide Steroid Prescription for Acute Spinal Cord Injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To continue the line of a previous publication using steroid for acute spinal cord injury (SCI) by spine surgeons from Latin America (LA) and assess the current status of methylprednisolone (MP) prescription in Europe (EU), Asia Pacific (AP), North America (NA), and Middle East (ME) to determine targets for educational activities suitable for each region. METHODS: The English version of a previously published questionnaire was used to evaluate opinions about MP administration in acute SCI in LA, EU, AP, NA, and ME. This Internet-based survey was conducted by members of AOSpine. The questionnaire asked about demographic features, background with management of spine trauma patients, routine administration of MP in acute SCI, and reasons for MP administration. RESULTS: A total of 2659 responses were obtained for the electronic questionnaire from LA, EU, AP, NA, and ME. The number of spine surgeons that treat SCI was 2206 (83%). The steroid was used by 1198 (52.9%) surgeons. The uses of MP were based predominantly on the National Acute Spinal Cord Injury Study III study (n = 595, 50%). The answers were most frequently given by spine surgeons from AP, ME, and LA. These regions presented a statistically significant difference from North America (P < .001). The number of SCI patients treated per year inversely influenced the use of MP. The higher the number of patients treated, the lower the administration rates of MP observed. CONCLUSIONS: The study identified potential targets for educational campaigns, aiming to reduce inappropriate practices of MP administration.

Current Status of Worldwide Use of Patient-Reported Outcome Measures (PROMs) in Spine Care.

OBJECTIVES: Patient-reported outcome measures (PROMs) are the most widely accepted means of measuring outcomes after spine procedures. We sought to determine the current status of worldwide use of PROMs in Latin America (LA), Europe (EU), Asia Pacific (AP), North America (NA), and Middle East (ME) to determine the barrier to its full implementation. METHODS: A questionnaire survey was sent by e-mail to members of AOSpine to evaluate their familiarity and use of PROMs instruments and to assess the barriers to their use in spine care practice in LA, EU, AP, NA, and ME. RESULTS: A total of 1634 AOSpine members from LA, EU, AP, NA, and ME answered the electronic questionnaire. The percentage of spine surgeons who were familiar with the generic health-related quality of life questionnaire was 71.7%. In addition, 31.9% of respondents did not use any PROMs routinely. The main barriers to implementing PROMs were lack of time to administer the questionnaires (57%) followed by lack of staff to assist in data collection (55%), and the long time to fill out the questionnaires (46%). The routine use of questionnaires was more frequent in NA and EU and less common in LA and ME (P < 0.001). CONCLUSIONS: We found that 31.9% of spine surgeons do not use the PROMs questionnaire routinely. This appears to occur because of lack of knowledge regarding their importance, absence of reimbursement for this extra work, minimal financial support for clinical research, the cost of implementation, and lack of concern among physicians.

Bilateral tubular minimally invasive surgery for low-dysplastic lumbosacral lytic spondylolisthesis (LDLLS): analysis of a series focusing on postoperative sagittal balance and review of the literature.

PURPOSE: To report our early experience with minimally invasive surgery (MIS) in low-dysplastic lumbosacral lytic spondylolisthesis (LDLLS), and to analyze the impact of surgery on postoperative spino-pelvic and sacro-pelvic parameters. METHODS: Eight patients (mean age 47.6 years) underwent MIS for LDLLS involving in all but one the L5-S1 level. VAS and ODI were used for clinical assessment. Imaging included pre-operative X-rays, CT and MRI scans. Post-operatively, all patients underwent X-rays and CT-scans. Pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS) values as well as lumbar lordosis (LL) have been derived from pre- and post-operative standard X-rays. RESULTS: Mean follow-up is 30.12 months (range 15-42). No complications related to the surgical procedure were observed. Patients reported a satisfactory clinical outcome, as demonstrated by variation in mean VAS (from 9.1 to 3.6) and ODI (from 70.50 to 28.25 %) scores. Comparison between pre- and post-operative sacro-pelvic parameters documented moderate changes, with reduction of PT and increase of SS in all but one patient. Overall sagittal balance of the spine has been evaluated using the sagittal vertical axis (SVA), obtained from post-operative X-rays. Mean value of SVA demonstrated a good sagittal balance of the spine. CONCLUSION: This series demonstrates that MIS is feasible and effective for LDLLS, as witnesses by the satisfactory clinical results maintained at medium-term follow-up. We submit that TLIF is a valid option but an adequately sized and positioned interbody cage is a key factor to allow satisfactory restoration of segmental lordosis.

Spinal epidural hematoma.

Spinal epidural hematoma is a rare condition that usually presents with acute, severe pain at the location of the hemorrhage, with radiation to the extremities. It can rapidly develop to include progressive and severe neurologic deficit. The pathophysiology often remains unclear. However, epidural hematoma in the lumbar spine is best described as the result of internal rupture of the Batson vertebral venous plexus. Clinical evaluation of pain control and neurologic deficit is the most important tool in early diagnosis. Currently, MRI is the diagnostic method of choice. Regardless of the setting, symptomatic spinal epidural hematoma is typically managed with urgent surgical decompression of the spinal canal.