Abstract：
OBJECTIVE: The incidence of spondylodiscitis is rising across Europe, but the ideal treatment approach remains controversial. The choice between conservative and surgical therapies is ambiguous due to a lack of consensus. This European survey aimed to explore prevailing treatment paradigms for primary spondylodiscitis.
METHODS: Spine neurosurgeons were invited through the European Association of Neurosurgical Societies Spine Section\'s mailing list to participate in an online survey featuring 7 spondylodiscitis case vignettes. Along with general management queries, specific patient treatment questions were posed. Data analysis was performed using R software (version 4.0.4). The index of qualitative variation (IQV) was calculated to quantify the variability in responses.
RESULTS: A total of 130 responses were collected, comprising 86.9% board-certified neurosurgeons and 13.1% neurosurgeons in training, with an average of 11 years of practice. Most respondents performed 50-100 spine surgeries annually, with 66.7% specializing in spine surgery. An epidural empyema causing pronounced neurological deficits influenced 95.4% toward a surgical intervention, and mild neurological deficits and challenges in pathogen identification prompted 72.3% and 80%, respectively, to consider a surgical approach. Vertebral body destruction and spinal deformity directed 60% and 66.2%, respectively, toward surgery, whereas advanced age and comorbidities had a much smaller impact-5.4% and 9.2%, respectively. Clinical vignettes highlighted a predominant preference for conservative treatment in specific cases, with statistical significance (p < 0.05). The IQV values evaluated for each question ranged from 0.88 to 0.99, indicating low agreement across all questions among respondents. When examining the average IQV by country, intercountry variations in IQV were substantial, as illustrated by the diverse range of overall mean IQV values (0.15-0.85).
CONCLUSIONS: The findings reveal a significant variability in the treatment of spondylodiscitis among European neurosurgeons, with most neurosurgeons opting for conservative treatment. These diverse strategies, both between and within countries, highlight an imperative for evidence-backed guidelines and consensus statements for this grave condition.
METHODS: Spine neurosurgeons were invited through the European Association of Neurosurgical Societies Spine Section\'s mailing list to participate in an online survey featuring 7 spondylodiscitis case vignettes. Along with general management queries, specific patient treatment questions were posed. Data analysis was performed using R software (version 4.0.4). The index of qualitative variation (IQV) was calculated to quantify the variability in responses.
RESULTS: A total of 130 responses were collected, comprising 86.9% board-certified neurosurgeons and 13.1% neurosurgeons in training, with an average of 11 years of practice. Most respondents performed 50-100 spine surgeries annually, with 66.7% specializing in spine surgery. An epidural empyema causing pronounced neurological deficits influenced 95.4% toward a surgical intervention, and mild neurological deficits and challenges in pathogen identification prompted 72.3% and 80%, respectively, to consider a surgical approach. Vertebral body destruction and spinal deformity directed 60% and 66.2%, respectively, toward surgery, whereas advanced age and comorbidities had a much smaller impact-5.4% and 9.2%, respectively. Clinical vignettes highlighted a predominant preference for conservative treatment in specific cases, with statistical significance (p < 0.05). The IQV values evaluated for each question ranged from 0.88 to 0.99, indicating low agreement across all questions among respondents. When examining the average IQV by country, intercountry variations in IQV were substantial, as illustrated by the diverse range of overall mean IQV values (0.15-0.85).
CONCLUSIONS: The findings reveal a significant variability in the treatment of spondylodiscitis among European neurosurgeons, with most neurosurgeons opting for conservative treatment. These diverse strategies, both between and within countries, highlight an imperative for evidence-backed guidelines and consensus statements for this grave condition.
摘要：
目标：整个欧洲脊柱盘炎的发病率正在上升，但是理想的治疗方法仍然存在争议。由于缺乏共识，保守治疗和手术治疗之间的选择是模糊的。这项欧洲调查旨在探索原发性脊椎盘炎的流行治疗模式。
方法：通过欧洲神经外科协会脊柱科的邮件列表邀请脊柱神经外科医生参加了一项在线调查，该调查以7例脊柱盘炎病例为特色。除了一般的管理查询，提出了具体的患者治疗问题。使用R软件(4.0.4版)进行数据分析。计算定性变异指数（IQV）以量化响应的变异性。
结果：共收集了130份回复，包括86.9%的董事会认证神经外科医生和13.1%的神经外科医生，平均练习11年。大多数受访者每年进行50-100例脊柱手术，66.7%的人专门从事脊柱手术。导致明显神经功能缺损的硬膜外脓胸影响了95.4％的手术干预，和轻微的神经功能缺损和挑战在病原体识别促使72.3%和80%，分别,考虑手术方法.椎体破坏和脊柱畸形的发生率分别为60%和66.2%，分别,走向手术，而高龄和合并症的影响要小得多-5.4％和9.2％，分别。临床小插曲强调了在特定情况下对保守治疗的主要偏好，具有统计学意义(p<0.05)。每个问题评估的IQV值范围为0.88至0.99，表明受访者对所有问题的一致性较低。在按国家/地区检查平均IQV时，IQV的国家间差异很大，如总平均IQV值的不同范围(0.15-0.85)所示。
结论：研究结果揭示了欧洲神经外科医生在治疗脊椎盘炎方面的显着差异，大多数神经外科医生选择保守治疗。这些不同的策略，国家之间和国家内部，强调必须有证据支持的指导方针和共识声明，以解决这一严重的情况。
方法：通过欧洲神经外科协会脊柱科的邮件列表邀请脊柱神经外科医生参加了一项在线调查，该调查以7例脊柱盘炎病例为特色。除了一般的管理查询，提出了具体的患者治疗问题。使用R软件(4.0.4版)进行数据分析。计算定性变异指数（IQV）以量化响应的变异性。
结果：共收集了130份回复，包括86.9%的董事会认证神经外科医生和13.1%的神经外科医生，平均练习11年。大多数受访者每年进行50-100例脊柱手术，66.7%的人专门从事脊柱手术。导致明显神经功能缺损的硬膜外脓胸影响了95.4％的手术干预，和轻微的神经功能缺损和挑战在病原体识别促使72.3%和80%，分别,考虑手术方法.椎体破坏和脊柱畸形的发生率分别为60%和66.2%，分别,走向手术，而高龄和合并症的影响要小得多-5.4％和9.2％，分别。临床小插曲强调了在特定情况下对保守治疗的主要偏好，具有统计学意义(p<0.05)。每个问题评估的IQV值范围为0.88至0.99，表明受访者对所有问题的一致性较低。在按国家/地区检查平均IQV时，IQV的国家间差异很大，如总平均IQV值的不同范围(0.15-0.85)所示。
结论：研究结果揭示了欧洲神经外科医生在治疗脊椎盘炎方面的显着差异，大多数神经外科医生选择保守治疗。这些不同的策略，国家之间和国家内部，强调必须有证据支持的指导方针和共识声明，以解决这一严重的情况。
