Insights on High-Value Procedures From the ISASS 4-Part Webinar Series on Current and Emerging Techniques in Endoscopic Spine Surgery Based on Surgeon Experience

Kai-Uwe Lewandrowski; Zhen-Zhou Li; Xinyu Liu; Zhang Xifeng; Brian Kwon; Álvaro Dowling; Martin Knight; Paulo Sergio Terxeira de Carvalho; Choll Kim; Gregory W Basil; Gabriel Oswaldo Alonso Cuéllar; Christian Morgenstern; John Ongulade; Yi Jiang; Kenyu Ito; João Paulo Bergamaschi; Jin-Sung L Kim; Jorge F Ramirez; Joachim Oertel; John C Elfar; Abduljabbar Alhammoud; Nicholas A Bonazza; Benedikt W Burkhardt; Rossano Kepler Alvim Fiorelli; Sergio Luis Schmidt; Morgan P Lorio

doi:10.14444/8676

Insights on High-Value Procedures From the ISASS 4-Part Webinar Series on Current and Emerging Techniques in Endoscopic Spine Surgery Based on Surgeon Experience

Int J Spine Surg. 2024 Nov 20;18(S2):S66-S82. doi: 10.14444/8676.

Authors

Kai-Uwe Lewandrowski^{1

2

3

4}, Zhen-Zhou Li⁵, Xinyu Liu⁶, Zhang Xifeng⁷, Brian Kwon⁸, Álvaro Dowling^{9

10}, Martin Knight¹¹, Paulo Sergio Terxeira de Carvalho¹², Choll Kim¹³, Gregory W Basil¹⁴, Gabriel Oswaldo Alonso Cuéllar^{15

16}, Christian Morgenstern¹⁷, John Ongulade¹⁸, Yi Jiang¹⁹, Kenyu Ito²⁰, João Paulo Bergamaschi²¹, Jin-Sung L Kim²², Jorge F Ramirez^{23

24

25}, Joachim Oertel²⁶, John C Elfar²⁷, Abduljabbar Alhammoud²⁸, Nicholas A Bonazza²⁸, Benedikt W Burkhardt²⁹, Rossano Kepler Alvim Fiorelli³⁰, Sergio Luis Schmidt³¹, Morgan P Lorio^{32

33}

Affiliations

¹ Division Personalized Pain Research and Education, Center for Advanced Spine Care of Southern Arizona, Tucson, AZ, USA business@tucsonspine.com.
² Department of Orthopaedic Surgery, University of Arizona, Banner Medical Center, Tucson, AZ, USA.
³ Dr. honoris causa Department of Orthopedics at Hospital Universitário Gaffree Guinle, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
⁴ Department of Orthopedics, Hospital Universitário Gaffree Guinle Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
⁵ Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China.
⁶ Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan City, Shandong Province, China.
⁷ Department of Orthopedics, First Medical Center, PLA General Hospital, Beijing, China.
⁸ Department of Orthopaedics, New England Baptist Hospital, Boston, MA, USA.
⁹ Department of Orthopedic Surgery, USP, Ribeirão Preto, Brazil.
¹⁰ Spine Center, Endoscopic Spine Clinic, Santiago, Chile.
¹¹ The Spinal Foundation, Manchester University, The Weymouth Hospital, London, UK.
¹² Department of Neurosurgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.
¹³ Department of Orthopaedic Surgery, UCSD Medical Center East Campus, Excell Spine Center, San Diego, CA, USA.
¹⁴ Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
¹⁵ Department of Orthopaedics, Clínica Reina Sofía - Clínica Colsanitas, Bogotá, D.C., Colombia.
¹⁶ Latin American Endoscopic Spine Surgeons LESS Invasiva Academy, Bogotá, D.C., Colombia.
¹⁷ Morgenstern Institute of Spine, Teknon Medical Center, Barcelona, Spain.
¹⁸ Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA.
¹⁹ Department of Orthopaedics, Beijing Haidian Hospital, Beijing, China.
²⁰ Department of Spinal Surgery, Aichi Spine Institute, Fuso-cho Niwa-gun Aichi, Japan.
²¹ Orthopaedic Spine Surgery, Atualli Spine Care, São Paulo, Brazil.
²² Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
²³ Department of Orthopaedic, Minimally Invasive Spine Center, Bogotá, D.C., Colombia.
²⁴ Department of Orthopaedics, Reina Sofía Clinic, Bogotá, D.C., Colombia.
²⁵ Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá, D.C., Colombia.
²⁶ Neurosschirurgie, Universitätsklinikum des Saarlandes Neurosschirurgie, Homburg, Saarland, Germany.
²⁷ Department of Orthopedics and Sports Medicine, University of Arizona College of Medicine, Tucson, AZ, USA.
²⁸ Department of Orthopedic Surgery, University of Arizona College of Medicine, Tucson, AZ, USA.
²⁹ Wirbelsäulenzentrum/Spine Center, WSC Hirslanden Klinik Zurich, Zurich, Switzerland.
³⁰ Department of Thoracic Surgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.
³¹ Department of Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.
³² Advanced Orthopedics, Altamonte Springs, Orlando, FL, USA.
³³ Orlando College of Osteopathic Medicine, Orlando, FL, USA.

PMID: 39547675
DOI: 10.14444/8676

Abstract

Background: The authors conducted a comprehensive review and integration of insights from 4 webinars hosted by the International Society for the Advancement of Spine Surgery (ISASS) to arrive at recommendations for best clinical practices for guideline development for endoscopic spine surgery. This perspective article discusses the limitations of traditional surgical trials and amalgamates surgeons' experience and research on various cutting-edge techniques.

Methods: Data were extracted from surveys conducted during each webinar session involving 3639 surgeons globally. The polytomous Rasch model was employed to analyze responses, ensuring a robust statistical assessment of surgeon endorsements and educational impacts and focusing on operative nuances and experience-based outcomes. Bias detection was performed using the differential item functioning test.

Results: The ISASS webinars provided a dynamic platform for discussing advances in endoscopic spine surgery, identifying a range of high-value procedures from basic discectomies to complex lumbar interbody fusions. Each high-value endoscopic spine surgery was highlighted in separate peer-reviewed publications, which form the basis for this summary document that synthesizes key takeaways from these webinars. High-value clinical applications of endoscopic spine surgery, primarily defined as higher-intensity endorsement transformation from the pre- to postwebinar survey with a shift to higher mean logit locations of test items both with unbiased and orderly threshold progression, were: (a) Percutaneous interlaminar endoscopic decompression for lateral canal stenosis, (b) transforaminal debridement of low-grade degenerative spondylolisthesis, (c) transforaminal full-endoscopic interbody fusion for hard disc herniation, (d) endoscopic standalone lumbar interbody fusion, (e) endoscopic debridement of spondylolytic spondylolisthesis, and (f) posterior cervical foraminotomy for herniated disc and bony stenosis.

Conclusions: The ISASS webinar series has significantly impacted surgeons' education and contributed to the identification of high-value endoscopic spine surgery practices that may serve as a cornerstone for surgeon training standards, policy, and guidelines development. Ongoing research on technological advancements and expansions of clinical indications combined with systematic review is expected to refine the recommendations on high-value endoscopic spinal surgeries recommended for enhanced reimbursement.

Clinical relevance: Assessing surgeon confidence and acceptance of endoscopic spinal surgeries using polytomous Rasch analysis.

Level of evidence: Level 2 (inferential) and 3 (observational) evidence because Rasch analysis provides statistical validation of instruments rather than direct clinical outcomes.

Keywords: Rasch analysis; bias detection; clinical guidelines development; endoscopic spine surgery; high-value surgical procedures; surgeon experience; surgical trial limitations.

This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2024 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.