We thank Dr. Pearson for his insightful commentary on our manuscript “Variation in Outcomes Across Centers After Surgery for Lumbar Stenosis and Degenerative Spondylolisthesis in the Spine Patient Outcomes Research Trial”1. The study demonstrated statistically significant variation in several short-term and long-term outcomes after decompression, fusion, or both, in patients with spinal stenosis or degenerative spondylolisthesis. These findings are in line with previous literature showing variation in outcomes in patients undergoing these procedures, but the study is the first to isolate center-specific effects. Potential reasons for variation across centers include differences in center volume, surgeon experience, surgical technique and selection criteria for surgery. Surgical selection in particular has been shown to differ across the country, with wide variation in rates of lumbar laminectomy and fusion2.
Another recent analysis of the SPORT cohort found similar outcomes after lumbar discectomy across participating centers3. The implications of these combined data include the possibility that certain procedures such as lumbar fusion require greater expertise for optimal outcomes. As we attempt to define and maximize quality in surgical care, such a possibility may have an important role in ongoing discussions regarding regionalization of care, training and subspecialization.
1. Variation in outcomes across centers after surgery for lumbar stenosis and degenerative spondylolisthesis in the spine patient outcomes research trial. Desai A, Bekelis K, Ball PA, Lurie J, Mirza SK, Tosteson TD, Zhao W, Weinstein JN.
Spine (Phila Pa 1976). 2013 Apr 15;38(8):678-91.
2. Weinstein JN, Birkmeyer JD. The Dartmouth Atlas of Musculoskeletal Health Care. Chicago, IL: AHA press; 2010.
3. Spine patient outcomes research trial: do outcomes vary across centers for surgery for lumbar disc herniation? Desai A, Bekelis K, Ball PA, Lurie J, Mirza SK, Tosteson TD, Zhao W, Weinstein JN. Neurosurgery. 2012 Oct;71(4):833-42.