Safety Culture and Attitudes Among Spine Professionals: Results of an International Survey

Study Design: International survey. Objective: A positive safety culture has been linked to better surgical outcomes, less hospital costs and less patient harm and severity-adjusted mortality, making safety attitudes relevant for society and both patient and health care provider. The aim of the current study is to assess attitudes toward safety culture among spinal care professionals. Methods: An online survey was distributed to members of AOSpine International in 2016. The survey consisted out of 3 parts: (1) demographics, (2) the Safety Attitude Questionnaire (SAQ), and (3) expectations of responsibility for improving the safety culture. The SAQ measured job satisfaction, teamwork, and safety climate, perceptions of management, stress recognition, and working conditions. Multivariate logistic regression was performed to identify factors associated with safety attitudes. Results: A total of 356 respondents replied. The SAQ showed that respondents in Africa have a significant lower score (odds ratio [OR] 0.19, P .05). The majority expected the surgeon to be mainly responsible for improving the safety culture in the operating room and at management level. Conclusions: There was a lot of variety among different respondents worldwide albeit respondents in Africa scored significantly lower on working conditions, compared with spine professionals in Asia and North America, suggesting that wealthier countries have better working conditions which may lead toward better safety attitudes. Closer collaboration between hospital management and clinicians seems to be a target for improvement in safety culture. Furthermore, to show clinical relevance in this field, studies correlating safety attitudes with outcomes after spine surgery are warranted

Spontaneous externalization of a ventriculoperitoneal shunt tip through the navel

The authors describe spontaneous externalization of a ventriculo-peritoneal shunt through the navel

The neurosurgical curriculum: Which procedures are essential?

Objective: Traditionally, neurosurgery is a competitive field. Throughout the years, the surgical armamentarium has been subject to change, e.g. due to the rise of indications for gamma knife, functional or endovascular surgery. Furthermore, due to modern day issues among residents, such as work hour restrictions (WHRs) and prevalence of burn-out, may require contemporary modifications of the neurosurgical curriculum. By the means of this cross sectional research, the current curriculum is evaluated. Methods: In September 2019, a 21-question survey was mailed to members of the Congress of Neurological Surgeons using SurveyMonkey. The survey consisted out of 3 parts: demographics of the respondents, respondent‘s neurosurgical residency and opinions on essential procedures. Results: After the two reminders, 578 members responded resulting in a response rate of 7.3%. Respondents had a mean residency program of 7 years (range 3 to 12 years). Of the residents, 87.5% had a weekly WHR of 80 h per week. A minority (43.8%) felt WHRs would limit the chances of residents to master surgical techniques. Neurotraumatical procedures such as decompression of subdural (91.5%) and epidural (91.3%) hematoma‘s, ventriculoperitoneal shunt insertion (86.9%), Chiari decompression (81.4%) and cervical discectomy (81.4%) were the procedures respondents mastered the most. This in contrast to endovascular procedures (67.9%), percutaneous endoscopic lumbar discectomy (48.5%) and deep brain stimulation (34%), in which respondents were less proficient. Conclusions: The current study gives an evaluation of different neurosurgical curricula and aimed to identify which surgical procedures are deemed as essential by neurosurgeons worldwide. Functiona

Practice variation in the conservative and surgical treatment of chronic subdural hematoma

Objective: Chronic subdural hematoma (CSDH) is a condition that is frequently seen in the neurological and neurosurgical practice. Surgical treatment is overall preferred; however, conservative treatment is also an option. Both surgical and conservative treatment of CSDH vary across neurosurgeons. The aim of the present study was to evaluate different treatment strategies for CSDH among neurosurgeons in different countries. Material and Methods: We designed a survey that was sent to neurosurgeons affiliated with the Congress of Neurological Surgeons.The questions were related to the conservative and surgical treatment methods of CSDH. Furthermore, we also included questions related to post-operative care. Results: 443 neurosurgeons completed the survey. 46.2 % of the respondents sometimes use dexamethasone as monotherapy. Overall, 26.2 % estimated dexamethasone to have a high efficacy on CSDH. A Glas

Anterior cervical discectomy without fusion for a symptomatic cervical disk herniation

Background: Cervical radiculopathy is characterized by dysfunction of the nerve root usually caused by a cervical disk herniation. The most important symptom is pain, radiating from the neck to the arm. When conservative treatment fails, surgical treatment is indicated to relieve symptoms. During the last decades, multiple fusion techniques have been developed, although without clinical evidence for added value of fusion over non-fusion. Methods: The surgical procedure of anterior cervical discectomy without fusion is performed step by step, leading to removal of the entire intervertebral disk. Conclusion: Anterior cervical discectomy without fusion is a safe and effective treatment for cervical disk herniation

Outcome of non-instrumented lumbar spinal surgery in obese patients: a systematic review

Introduction: Lumbar spinal decompression procedures are well known in their techniques and outcomes. However, outcomes of lumbar spinal surgery in patients with obesity are relatively unknown. The aim of this review is to assess the effect of obesity on post-operative outcomes of lumbar non-instrumented decompressive spinal surgery. Methods and materials: A literature search through PubMed, Embase, Web of Science and Cochrane was performed. Articles were included if they reported outcomes of obese patients after non-instrumented lumbar decompression surgery, if these outcomes were described using patient-reported outcome measures and if there was at least two months of follow-up. Risk of bias was assessed using an adjusted version of the Cowley score. Results: From the 222 unique articles, 14 articles, comprising 13,653 patients, met the inclusion criteria. Eight out of 14 studies had a low risk of bias, while the remaining six had an intermediate risk of bias. Thirteen studies evaluated leg and back pain, and the vast majority demonstrated less decrease in pain in the obese group. Six studies evaluated disability and all but one showed less improvement in obese patients. Five studies evaluated functionality and wellbeing and all but one showed less satisfactory outcome in obese patients. Conclusions: Literature does not reveal a difference in clinical outcome nor in complications in patients undergoing non-instrumented lumbar surgery with a BMI lower than 30 or equal to or higher than 30. This may be used by physicians to inform patients prior to lumbar decompression surgery

How I do it: percutaneous transforaminal endoscopic discectomy for lumbar disk herniation

Background: Percutaneous transforaminal endoscopic discectomy (PTED) has emerged as a less invasive technique to treat symptomatic lumbar disk herniation (LDH). PTED is performed under local anesthesia with the advantage of immediate intraoperative feedback of the patient. In this paper, the technique is described as conducted in our hospital. Methods: PTED is performed under local anesthesia in prone position on thoracopelvic supports. The procedure is explained stepwise: e.g. marking, incision, introduction of the 18-gauge needle and guidewire to the superior articular process, introduction of the TomShidi needle and foraminotomy up to 9 mm, with subsequently removal of di

Mistreatment, discrimination and burn-out in Neurosurgery

Objective: Issues concerning harassment, bullying and discrimination are not unknown to medical specialties and are likely to be present in neurosurgery as well. The aim of this study was to estimate the extent to which neurosurgeons are faced with issues pertaining to this mistreatment. Methods: A survey consisting of fourteen questions was distributed among members of the Congress of Neurological Surgeons (CNS). The survey consisted of three parts: 1) demographics; 2) exposure to mistreatment; 3) experienced burnout symptoms. Results: In total 503 out of the 5665 approached CNS members filled in a survey (response rate 8.9 %). Respondents consisted for 85.9 % out of neurosurgeons and for 13.9 % out of residents. Overall, 61.4 % of the respondents was a victim of form of abusive behavior, while 47.9 % was a victim of at least one form of discrimination. Most reported sources of these mistreatments were other neurosurgeons or (family of) patients. Overall, 49.9 % of the respondents experienced burnout symptoms. Multivariable logistic regression analysis showed that female respondents had higher odds of being a victim of abuse (OR 2.5, 95 % CI 1.4–4.6). Female respondents (OR 19.8, 95 % CI 8.9–43.9) and ethnic minorities (OR 3.8, 95 % CI 2.3–6.2) had higher odds of being a victim of discrimination. Furthermore, victims of abuse were at higher odds (OR 1.7, 95 % CI 1.1–2.6) of having burnout symptoms. Conclusions: Mistreatment and experiencing burnout symptoms frequently occurs among neurosurgeons and residents

Lumbale herniaoperatie: Endoscopisch of open?

_Achtergrond en het waarom van de studie_ In Nederland vinden jaarlijks veel operaties voor een lumbale discushernia plaats. Patiënten krijgen meestal een open microdiscectomie, waarbij de hernia wordt opgeheven via een klein sneetje in de rug en de zenuwwortel wordt vrijgelegd (figuur a). Een andere techniek is percutane transforaminale endoscopische discectomie (PTED) (figuur b). Hierbij wordt de hernia onder indirect zicht opgeheven door een kleinere snee van 8 mm via het wortelkanaal, dus meer vanaf de zijkant. PTED vindt plaats in dagbehandeling onder lichte sedatie, waardoor de patiënt gedurende de ingreep aanspreekbaar is. Mogelijke voordelen van deze techniek zijn minder risico op littekenvorming en een snellere revalidatie. Een mogelijk nadeel is een groter risico op recidieven omdat er minder discusmateriaal kan worden uitgeruimd. PTED behoort nog niet tot het basispakket, omdat Zorginstituut Nederland meent dat PTED niet voldoet aan de stand van de wetenschap en praktijk. Met de PTED-studie willen wij de hypothese toetsen dat PTED bij patiënten met een lumbale hernia niet minder effectief is dan open microdiscectomie. Daarnaast zullen wij ook de kosteneffectiviteit analyseren. _Vraagstelling:_ Is PTED niet minder effectief en niet minder kosteneffectief dan microdiscectomie bij patiënten met lumbosacraal radiculair syndroom door een discushernia

Global adoption of robotic technology into neurosurgical practice and research

Recent technological advancements have led to the development and implementation of robotic surgery in several specialties, including neurosurgery. Our aim was to carry out a worldwide survey among neurosurgeons to assess the adoption of and attitude toward robotic technology in the neurosurgical operating room and to identify factors associated with use of robotic technology. The online survey was made up of nine or ten compulsory questions and was distributed via the European Association of the Neurosurgical Societies (EANS) and the Congress of Neurological Surgeons (CNS) in February and March 2018. From a total of 7280 neurosurgeons who were sent the survey, we received 406 answers, corresponding to a response rate of 5.6%, mostly from Europe and North America. Overall, 197 neurosurgeons (48.5%) reported having used robotic technology in clinical practice. The highest rates of adoption of robotics were observed for Europe (54%) and North America (51%). Apart from geographical region, only age under 30, female gender, and absence of a non-academic setting were significantly associated with clinical use of robotics. The Mazor family (32%) and ROSA (26%) robots were most commonly reported among robot users. Our study provides a worldwide overview of neurosurgical adoption of robotic technology. Almost half of the surveyed neurosurgeons reported having clinical experience with at least one robotic system. Ongoing and future trials should aim to clarify superiority or non-inferiority of neurosurgical robotic applications and balance these potential benefits with considerations on acquisition and maintenance costs