PDF(Pubmed)
Abstract：
METHODS: Retrospective analysis of prospectively collected data.
OBJECTIVE: To compare decision-making between an expert panel and real-world spine surgeons in thoracolumbar burst fractures (TLBFs) without neurological deficits and analyze which factors influence surgical decision-making.
METHODS: This study is a sub-analysis of a prospective observational study in TL fractures. Twenty two experts were asked to review 183 CT scans and recommend treatment for each fracture. The expert recommendation was based on radiographic review.
RESULTS: Overall agreement between the expert panel and real-world surgeons regarding surgery was 63.2%. In 36.8% of cases, the expert panel recommended surgery that was not performed in real-world scenarios. Conversely, in cases where the expert panel recommended non-surgical treatment, only 38.6% received non-surgical treatment, while 61.4% underwent surgery. A separate analysis of A3 and A4 fractures revealed that expert panel recommended surgery for 30% of A3 injuries and 68% of A4 injuries. However, 61% of patients with both A3 and A4 fractures received surgery in the real world. Multivariate analysis demonstrated that a 1% increase in certainty of PLC injury led to a 4% increase in surgery recommendation among the expert panel, while a .2% increase in the likelihood of receiving surgery in the real world.
CONCLUSIONS: Surgical decision-making varied between the expert panel and real-world treating surgeons. Differences appear to be less evident in A3/A4 burst fractures making this specific group of fractures a real challenge independent of the level of expertise.
OBJECTIVE: To compare decision-making between an expert panel and real-world spine surgeons in thoracolumbar burst fractures (TLBFs) without neurological deficits and analyze which factors influence surgical decision-making.
METHODS: This study is a sub-analysis of a prospective observational study in TL fractures. Twenty two experts were asked to review 183 CT scans and recommend treatment for each fracture. The expert recommendation was based on radiographic review.
RESULTS: Overall agreement between the expert panel and real-world surgeons regarding surgery was 63.2%. In 36.8% of cases, the expert panel recommended surgery that was not performed in real-world scenarios. Conversely, in cases where the expert panel recommended non-surgical treatment, only 38.6% received non-surgical treatment, while 61.4% underwent surgery. A separate analysis of A3 and A4 fractures revealed that expert panel recommended surgery for 30% of A3 injuries and 68% of A4 injuries. However, 61% of patients with both A3 and A4 fractures received surgery in the real world. Multivariate analysis demonstrated that a 1% increase in certainty of PLC injury led to a 4% increase in surgery recommendation among the expert panel, while a .2% increase in the likelihood of receiving surgery in the real world.
CONCLUSIONS: Surgical decision-making varied between the expert panel and real-world treating surgeons. Differences appear to be less evident in A3/A4 burst fractures making this specific group of fractures a real challenge independent of the level of expertise.
摘要：
方法：对前瞻性收集的数据进行回顾性分析。
目的：比较无神经功能缺损的胸腰椎爆裂骨折（TLBF）专家小组与实际脊柱外科医生的决策，并分析哪些因素影响手术决策。
方法：本研究是一项针对TL骨折的前瞻性观察性研究的子分析。22位专家被要求检查183次CT扫描，并建议对每个骨折进行治疗。专家建议是基于射线照相审查。
结果：专家小组和现实世界的外科医生在手术方面的总体一致性为63.2%。在36.8%的病例中，专家小组推荐了在实际情况下未进行的手术.相反，在专家小组建议非手术治疗的情况下，只有38.6%接受了非手术治疗,61.4%接受了手术。对A3和A4骨折的单独分析显示，专家小组建议对30％的A3损伤和68％的A4损伤进行手术。然而,61％的A3和A4骨折患者在现实世界中接受了手术。多变量分析表明，PLC损伤的确定性增加1％导致专家小组的手术推荐增加4％，而在现实世界中接受手术的可能性增加了2%。
结论：专家小组和实际治疗外科医生之间的外科决策各不相同。A3/A4爆裂性骨折的差异似乎不太明显，这使该组特定的骨折成为真正的挑战，而与专业知识水平无关。
目的：比较无神经功能缺损的胸腰椎爆裂骨折（TLBF）专家小组与实际脊柱外科医生的决策，并分析哪些因素影响手术决策。
方法：本研究是一项针对TL骨折的前瞻性观察性研究的子分析。22位专家被要求检查183次CT扫描，并建议对每个骨折进行治疗。专家建议是基于射线照相审查。
结果：专家小组和现实世界的外科医生在手术方面的总体一致性为63.2%。在36.8%的病例中，专家小组推荐了在实际情况下未进行的手术.相反，在专家小组建议非手术治疗的情况下，只有38.6%接受了非手术治疗,61.4%接受了手术。对A3和A4骨折的单独分析显示，专家小组建议对30％的A3损伤和68％的A4损伤进行手术。然而,61％的A3和A4骨折患者在现实世界中接受了手术。多变量分析表明，PLC损伤的确定性增加1％导致专家小组的手术推荐增加4％，而在现实世界中接受手术的可能性增加了2%。
结论：专家小组和实际治疗外科医生之间的外科决策各不相同。A3/A4爆裂性骨折的差异似乎不太明显，这使该组特定的骨折成为真正的挑战，而与专业知识水平无关。
