Surgeon motivation, and obstacles to the implementation of minimally invasive spinal surgery techniques

Kai-Uwe Lewandrowski, José-Antonio Soriano-Sánchez, Xifeng Zhang, Jorge Felipe Ramírez León, Sergio Soriano Solis, José Gabriel Rugeles Ortíz, Carolina Ramírez Martínez, Gabriel Oswaldo Alonso Cuéllar, Kaixuan Liu, Qiang Fu, Marlon Sudário de Lima e Silva, Paulo Sérgio Teixeira de Carvalho, Stefan Hellinger, Álvaro Dowling, Nicholas Prada, Gun Choi, Girish Datar, Anthony Yeung


Background: This study aimed to analyze the motivators and obstacles to the implementation of minimally invasive spinal surgery techniques (MISST) by spinal surgeons. Motivators and detractors may impact the availability of MISST to patients and drive spine surgeons’ clinical decision-making in the treatment of common degenerative conditions of the lumbar spine.
Methods: The authors solicited responses to an online survey sent to spine surgeons by email, and chat groups in social media networks including Facebook, WeChat, WhatsApp, and Linkedin. Descriptive statistics were employed to count the responses and compared to the surgeon's training. Kappa statistics and linear regression analysis of agreement were performed.
Results: A total of 430 surgeons accessed the survey. The completion rate was 67.4%. A total of 292 surveys were submitted by 99 neurosurgeons (33.9%), 170 orthopaedic surgeons (58.2%), and 23 surgeons of other postgraduate training (7.9%). Personal interest (82.5%) and patient demand (48.6%) were the primary motivators for MISST implementation. High equipment (48.3%) and disposables (29.1%) cost were relevant obstacles to MISST implementation. Local workshops (47.6%) and meetings in small groups (31.8%) were listed as the primary knowledge sources. Only 12% of surgeons were fellowship trained, but 46.3% of surgeons employed MISST in over 25% of their cases.
Conclusions: The rate of implementation of MISST reported by spine surgeons was found to be high but impeded by the high cost of equipment and disposables. The primary motivators for spine surgeons’ desire to implement were personal interest and patient demand.