VARIATION IN SURGICAL OPINION REGARDING MANAGEMENT OF SELECTED CERVICAL-SPINE INJURIES - A PRELIMINARY-STUDY

Study Design. The opinions of orthopedic surgeons and neurosurgeons we re compared regarding appropriate management selected cervical injurie s and the timing of stabilization. Objective. To determine whether the re is consistency of opinion regarding the management of cervical trau ma. Summary of background Data. Numerous forms of management for cervi cal trauma exist, but there are few consistent recommendations. No pre vious study has been done to determine uniformity of preferences of th e surgeons who manage these injuries. Methods. Thirty-one orthopedic s urgeons and neurosurgeons were given a brief clinical situation and pe rtinent radiographic studies of five selected cervical injuries. Manag ement options included halo and nonhalo orthoses, traction, and variou s forms of anterior and/or posterior procedures. The surgeons rated, i n whole numbers from 1 to 10, their opinions on the appropriateness of each technique. Each surgeon was given a case of a ''generic'' cervic al injury, in which stabilization was required and for which preoperat ive alignment was adequate in traction. They gave opinions on the timi ng of stabilization, with a choice of four time frames. Four neurologi c situations were rated, ranging from intact to complete cord injury. Results. Of 46 possible responses to the five test cases regarding app ropriateness, 18 ranged from 1 to 10,the largest possible variation. O nly 2 had a range of 5 or less, implying better consensus among tested surgeons. Mean values ranged from 1.9 to 9.5. Agreement among respond ents regarding appropriateness was slight with a rang of kappa statist ics from 0.09 to 0.14. Of 16 possible responses regarding timing, 14 w ere within a range of 8 or higher. Within 24 to 72 hours was the gener ally preferred time frame, with all possible responses showing a range of 3 or 4. Results of a multiple analysis of variance showed no signi ficant differences among respondents. Conclusion. There is a large var iety of opinion regarding appropriateness of specific operative and no noperative management procedures and surgical timing among the surgeon s polled who manage cervical trauma. This implies that there is no wid ely accepted standard management procedure for many of these injuries.