{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T03:13:04Z","timestamp":1740107584929,"version":"3.37.3"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T00:00:00Z","timestamp":1716163200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T00:00:00Z","timestamp":1716163200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004477","name":"Stellenbosch University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004477","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Spine J"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>To investigate variation in treatment decisions among spine surgeons in South Africa and the association between surgeon characteristics and the treatment they select.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We surveyed 79 South African spine surgeons. We presented four vignettes (cervical spine distractive flexion injury, lumbar disc herniation, degenerative spondylolisthesis with stenosis, and insufficiency fracture) for them to assess and select treatments. We calculated the index of qualitative variation (IQV) to determine the degree of variability within each vignette. We used Fisher\u2019s exact, and Kruskal\u2013Wallis tests to assess the relationships between surgeons\u2019 characteristics and their responses per vignette. We compared their responses to the recommendations of a panel of spine specialists.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>IQVs showed moderate to high variability for cervical spine distractive flexion injury and insufficiency fracture and slightly lower levels of variability for lumbar disc herniation and degenerative spondylolisthesis with stenosis. This confirms the heterogeneity in South African spine surgeons\u2019 management of spinal pathologies. The surgeon characteristics associated with their treatment selection that\u00a0were important were caseload, experience and training, and external funding. Also, 19% of the surgeons selected a treatment option that the Panel did not support.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The findings make a case for evaluating patient outcomes and costs to identify value-based care. Such research would help countries that are seeking to contract with providers on value. Greater uniformity in treatment and easily accessible outcomes reporting would provide guidance for patients. Further investment in training and participation in fellowship programs may be necessary, along with greater dissemination of information from the literature.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00586-024-08295-6","type":"journal-article","created":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T19:01:43Z","timestamp":1716231703000},"page":"2577-2593","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgeon variation: a south african spinal pathology treatment survey"],"prefix":"10.1007","volume":"33","author":[{"given":"Pamela A.","family":"Vorster","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronelle","family":"Burger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theresa N.","family":"Mann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lungiswa L.","family":"Nkonki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helmuth","family":"Reuter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johan H.","family":"Davis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,5,20]]},"reference":[{"issue":"23","key":"8295_CR1","doi-asserted-by":"publisher","first-page":"2707","DOI":"10.1097\/01.brs.0000248132.15231.fe","volume":"31","author":"JN Weinstein","year":"2006","unstructured":"Weinstein JN, Lurie JD, Olson PR, Bronner KK, Fisher ES (2006) United States\u2019 trends and regional variations in lumbar spine surgery: 1992\u20132003. Spine 31(23):2707\u20132714. https:\/\/doi.org\/10.1097\/01.brs.0000248132.15231.fe","journal-title":"Spine"},{"issue":"3","key":"8295_CR2","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1097\/BRS.0000000000002272","volume":"43","author":"B Debono","year":"2018","unstructured":"Debono B, Lonjon G, Galovich LA, Kerever S, Guiot B, Eicker S, Hamel O, Ringel F (2018) Indication variability in degenerative lumbar spine surgery: a four nation survey. Spine 43(3):185\u2013192. https:\/\/doi.org\/10.1097\/BRS.0000000000002272. (PMID: 28604486)","journal-title":"Spine"},{"issue":"19","key":"8295_CR3","doi-asserted-by":"publisher","first-page":"2214","DOI":"10.1097\/01.brs.0000181056.76595.f7","volume":"30","author":"Z Irwin","year":"2005","unstructured":"Irwin Z, Hilibrand A, Gustavel M, McLain R, Shaffer W, Myers M, Glaser J, Hart R (2005) Variation in surgical decision making for degenerative spinal disorders part II: cervical spine. 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The Lancet 382(9898):1121\u20131129. https:\/\/doi.org\/10.1016\/S0140-6736(13)61215-5","journal-title":"The Lancet"}],"container-title":["European Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-024-08295-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00586-024-08295-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-024-08295-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T22:05:20Z","timestamp":1721858720000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00586-024-08295-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,20]]},"references-count":13,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2024,7]]}},"alternative-id":["8295"],"URL":"https:\/\/doi.org\/10.1007\/s00586-024-08295-6","relation":{},"ISSN":["0940-6719","1432-0932"],"issn-type":[{"type":"print","value":"0940-6719"},{"type":"electronic","value":"1432-0932"}],"subject":[],"published":{"date-parts":[[2024,5,20]]},"assertion":[{"value":"6 April 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 April 2024","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 April 2024","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 May 2024","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"None of the authors has any potential conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the Health Research Ethics Committee of Stellenbosch University (reference number S20\/10\/291).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}