Prevalence of carpal tunnel syndrome symptoms among neurosurgical spine surgeons

Background

Neurosurgeons, particularly spine surgeons, have high exposure to vibrations via electric or pneumatic drills and repetitive motion. Although no data exist for the prevalence of carpal tunnel syndrome (CTS) among these surgeons, anecdotal evidence suggests the rate of symptoms is higher than in the general population.

Methods

An anonymous questionnaire was developed to assess demographics, practice patterns, presence of CTS symptoms, and treatment (time off, bracing, medication, injections, surgery). The survey was sent via anonymous email link to members of the AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerve.

Results

101 members responded: 44 reported at least one symptom related to CTS (43.6%). There was no statistically significant relationship between overall or spine case volume, the number of cases performed annually/daily, and CTS symptoms. Respondents working in non-teaching settings were significantly more likely to have CTS symptoms than academic teaching institutions (50.0% v. 45.0%; p = 0.0112).

Conclusions

Our survey demonstrated CTS to be more prevalent in spine neurosurgeons (43.6%) than in the general population (1-5%). The lack of significant association between most practice-based metrics and CTS symptoms may indicate that respondents have a minimum case volume that exceeds the amount of vibration exposure/repetitive motion to develop symptoms. The significantly increased prevalence of CTS among neurosurgeons at non-teaching institutions suggests that residents provide operative assistance offsetting the vibration exposure/repetitive motion by attendings. Further research may determine the root cause for the high prevalence of CTS in spine neurosurgeons and devise methods for reducing vibration exposure.

Incidence of spine surgery in the South African private healthcare sector: ten-year trends within a large open medical scheme

PURPOSE

Studies from developed countries suggest a dramatic increase in the utilization of spine surgery in recent decades, however less is known about spine surgery rates in the developing world. The aim of this study was to investigate ten-year trends in the incidence of spine surgery within South Africa's largest open medical scheme.

METHODS

This retrospective review included adult inpatient spine surgeries funded by the scheme between 2008 and 2017. The incidence of spine surgery was investigated by age group-overall and for degenerative pathologies, fusion and instrumentation. Surgeons per 100,000 members were determined. Trends were evaluated by linear regression and by crude 10-year change in incidence.

RESULTS

A total of 49,575 spine surgeries were included. The incidence of surgery for lumbar degenerative pathology showed a significant upward trend among 60-79 year olds but declined among 40-59 year olds. The incidence of lumbar fusion and lumbar instrumentation declined significantly among 40-59 year olds with little change among 60-79 year olds. The ratio of orthopaedic spinal surgeons decreased from 10.2 to 6.3 per 100,000 members whereas the ratio of neurosurgeons decreased from 7.6 to 6.5 per 100,000.

CONCLUSION

Spine surgery in the South African private healthcare sector bears some similarity to developed countries in that it is dominated by elective procedures for degenerative pathology. However, the findings did not reflect the marked increases in the utilization of spine surgery reported elsewhere. It is hypothesized that this may be partly related to differences in the supply of spinal surgery.

Postoperative bracing practices after elective lumbar spine surgery: A questionnaire study of U.S. spine surgeons

Background

There is limited data available on the use of orthoses across varying elective spine surgeries. When previously studied in 2009, inconsistent lumbar postoperative bracing practices were reported. The present study aimed to provide a ten-year update regarding postoperative bracing practices after elective lumbar surgery among United States (U.S.) spine surgeons.

Methods

A questionnaire was distributed to attendees of the Lumbar Spine Research Society Annual Meeting (April 2019). The questionnaire collected demographic information, and asked surgeons to identify if they used orthoses postoperatively after ten elective lumbar surgeries. Information regarding type of brace, duration of use, and reason for bracing was also collected. Chi-square tests and one-way analysis of variance (ANOVA) were used for comparisons.

Results

Seventy-three of 88 U.S. attending surgeons completed the questionnaire (response rate: 83%). The majority of respondents were orthopaedic surgery-trained (78%), fellowship-trained (84%), and academic surgeons (73%). The majority of respondents (60%) did not use orthoses after any lumbar surgery. Among the surgeons who braced, the overall bracing frequency was 26%. This rate was significantly lower than that reported in the literature ten years earlier (p<0.0001). Respondents tended to use orthoses most often after stand-alone lateral interbody fusions (43%) (p<0.0001). The average bracing frequency after lumbar fusions (34%) was higher than the average bracing frequency after non-fusion surgeries (16%) (p<0.0001). The most frequently utilized brace was an off the shelf lumbar sacral orthosis (66%), and most surgeons braced patients to improve pain (42%). Of surgeons who braced, most commonly did so for 2–4 months (57%).

Conclusion

Most surgeon respondents did not prescribe orthoses after varying elective lumbar surgeries, and the frequency overall was lower than a similar study conducted in 2009. There continues to be inconsistencies in postoperative bracing practices. In an era striving for evidence-based practices, this is an area needing more attention.

The short-term impact of COVID-19 pandemic on spine surgeons: a cross-sectional global study

Purpose

The outbreak of COVID-19 erupted in December 2019 in Wuhan, China. In a few weeks, it progressed rapidly into a global pandemic which resulted in an overwhelming burden on health care systems, medical resources and staff. Spine surgeons as health care providers are no exception. In this study, we try to highlight the impact of the crisis on spine surgeons in terms of knowledge, attitude, practice and socioeconomic burden.

Methods

This was global, multicentric cross-sectional study on 781 spine surgeons that utilized an Internet-based validated questionnaire to evaluate knowledge about COVID-19, availability of personal protective equipment, future perceptions, effect of this crisis on practice and psychological distress. Univariate and multivariate ordinal logistic regression analyses were used to evaluate the predictors for the degree of COVID-19 effect on practice.

Results

Overall, 20.2%, 52% and 27.8% of the participants were affected minimally, intermediately and hugely by COVID-19, respectively. Older ages (β = 0.33, 95% CI 0.11–0.56), orthopedic spine surgeons (β = 0.30, 95% CI 0.01–0.61) and those who work in the private sector (β = 0.05, 95% CI 0.19–0.61) were the most affected by COVID-19. Those who work in university hospitals (β = − 0.36, 95% CI 0.00 to − 0.71) were affected the least. The availability of N95 masks (47%) and disposable eye protectors or face shields (39.4%) was significantly associated with lower psychological stress (p = 0.01). Only 6.9%, 3.7% and 5% had mild, moderate and severe mental distress, respectively.

Conclusion

While it is important to recognize the short-term impact of COVID-19 pandemic on the practice of spine surgery, predicting where we will be standing in 6–12 months remains difficult and unknown. The COVID-19 crisis will probably have an unexpected long-term impact on lives and economies.

Patient impressions of reimbursement for orthopedic spine surgeons

The study aim was to understand patient impressions of reimbursement to orthopedic spine surgeons. Our findings revealed that the majority of patients significantly overestimate the amount surgeons are reimbursed per procedure. Despite this, most feel that surgeons are appropriately compensated. Additionally, many patients are unaware of the global billing period.