{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:00:42Z","timestamp":1772827242236,"version":"3.50.1"},"reference-count":90,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,5]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Variations exist among surgeons in the treatment of recurrent lumbar disc herniation (LDH), generating major issues in decision-making models. The authors aimed to identify international nuances in surgical treatment patterns, highlight the differences in responses in each country group and different treatment trends across countries, and identify factors that influence surgical decisions.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n An online survey with preformulated answers was submitted to 292 orthopedic surgeons and 223 neurosurgeons from 16 countries regarding 3 clinical vignettes (recurrence without low back pain, recurrence with severe low back pain, and recurrence with 2-level disc disease). The variability for each country was calculated according to the index of qualitative variation (IQV; ranging from 0 [no variability] to 1 [maximum variability]). To integrate the surgeons\u2019 perspectives, 2 Likert-type queries were submitted concerning the specific criteria for fusion and overall decision-making for each clinical case.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Except for the case of first recurrence with pure radiculopathy without instability or inflammatory disc disease, where the variability was low (mean IQV 0.24, redo discectomy 86.2%), the other cases showed high variability (mean IQV range 0.63\u20130.71), with frequent proposals for surgery with implants. For countries with low variability, a high rate of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) procedures (55.3%) and low rates of anterior\/combined procedures (5.9%) and posterolateral fusion (4.9%) were observed. For countries with high variability, a lower rate of PLIF\/TLIF procedures was observed (33.1%), with alternate proposals for anterior\/combined procedures (20.8%) and posterolateral fusion without interbody fusion (12.8%). Orthopedic surgeons performed significantly more procedures with implants compared with neurosurgeons (p < 0.01). Age, practice type, and the annual number of surgery cases did not play a significant role in the choice of procedures. The most important criteria for fusion were lumbar pain symptoms associated with radiculopathy (77.9% strongly agreed) and the existence of inflammatory disc disease (73.0%). Furthermore, 62.1% of the respondents strongly agreed with performing fusion for all second recurrences. For the final decision, surgeons agreed with following the literature (81.9%), selecting low-morbidity procedures (78.6%), and using a familiar technique (78.6%). Patient preference was an important and\/or very important decision factor for 64.1% of respondents.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Significant differences existed between spine surgeons in the surgical treatment of recurrent LDH. Intra- and intergroup variations were observed, reflecting the lack of consensus in the literature and the challenge of adapting differences in habits and training to the few existing guidelines.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.4.spine24303","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T14:34:53Z","timestamp":1757687693000},"page":"681-692","source":"Crossref","is-referenced-by-count":0,"title":["To fuse or not to fuse: surgical strategies for recurrent lumbar disc herniation from a 16-nation study"],"prefix":"10.3171","volume":"43","author":[{"given":"Bertrand","family":"Debono","sequence":"first","affiliation":[{"name":"Paris-Versailles Spine Center (CFD), Ramsay Sant\u00e9-H\u00f4pital Priv\u00e9 de Versailles, France;"}]},{"given":"Guillaume","family":"Lonjon","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Orthosud, Clinique St-Jean- Sud de France, Sant\u00e9Cit\u00e9 Group, St Jean de Vedas, Montpellier Metropole, France;"}]},{"given":"Luis","family":"Alvarez-Galovich","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Fundaci\u00f3n Jim\u00e9nez D\u00edaz University Hospital, Madrid, Spain;"}]},{"given":"Junseok","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Chungdam Wooridul Spine Hospital, Seoul, South Korea;"}]},{"given":"Thami","family":"Benzakour","sequence":"additional","affiliation":[{"name":"Zerktouni Orthopaedic Clinic, Casablanca, Morocco;"}]},{"given":"Marcos Antonio","family":"Dias","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Health Sciences Center, State University of Londrina, Brazil;"}]},{"given":"Bassel","family":"Diebo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, Rhode Island;"}]},{"given":"Gr\u00e9gory","family":"Edgard-Rosa","sequence":"additional","affiliation":[{"name":"Centre de chirurgie vert\u00e9brale (CCV), Clinique du Parc, Castelnau le Lez, France;"}]},{"given":"Dimitri","family":"Godefroy","sequence":"additional","affiliation":[{"name":"EM Lyon Business School, Ecully, France;"}]},{"given":"Khaled","family":"Hadhri","sequence":"additional","affiliation":[{"name":"Spinal Surgery Unit, Department of Orthopaedic Surgery, Charles Nicolle Hospital, Tunis, Tunisia;"}]},{"given":"Olivier","family":"Hamel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ramsay Sant\u00e9-Clinique des C\u00e8dres, Cornebarrieu, France;"}]},{"given":"David","family":"Kieser","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand;"}]},{"given":"Daniele","family":"Nicoli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Policlinico di Monza, Italy;"}]},{"given":"Yoji","family":"Ogura","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan;"}]},{"given":"Samuel","family":"Pantoja","sequence":"additional","affiliation":[{"name":"Centro de Colomna, Cl\u00ednica Universidad de Los Andes, Santiago, Chile;"}]},{"given":"Paulo","family":"Pereira","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o, Porto, Portugal;"}]},{"given":"Yong","family":"Qiu","sequence":"additional","affiliation":[{"name":"Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China;"}]},{"given":"Florian","family":"Ringel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Universit\u00e4tsmedizin Mainz, Germany;"}]},{"given":"Roozbeh","family":"Shafafy","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, United Kingdom;"}]},{"given":"Enrico","family":"Tessitore","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland;"}]},{"given":"Michael","family":"Grelat","sequence":"additional","affiliation":[{"name":"Spinal Surgery Unit, Clinique du Parc, Lyon, France; and"}]},{"given":"Jean-Marc","family":"Voyadzis","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, DC"}]}],"member":"1754","reference":[{"issue":"22","key":"b1","series-title":"N Engl J Med","first-page":"2245","article-title":"Surgery versus prolonged conservative treatment for sciatica","volume":"356","author":"Peul WC","year":"2007","unstructured":"Peul WC, van Houwelingen HC, van den Hout WB, Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356(22):2245\u20132256."},{"issue":"25","key":"b2","series-title":"Spine (Phila Pa 1976)","first-page":"2147","article-title":"Asymptomatic same-site recurrent disc herniation after lumbar discectomy: results of a prospective longitudinal study with 2-year serial imaging","volume":"36","author":"Lebow RL","year":"2011","unstructured":"Lebow RL, Adogwa O, Parker SL, Sharma A, Cheng J, McGirt MJ. Asymptomatic same-site recurrent disc herniation after lumbar discectomy: results of a prospective longitudinal study with 2-year serial imaging. Spine (Phila Pa 1976). 2011;36(25):2147\u20132151."},{"issue":"12","key":"b3","series-title":"Spine J","first-page":"1983","article-title":"Reoperations after primary and revision lumbar discectomy: study of a national-level cohort with eight years follow-up","volume":"22","author":"Dalal SS","year":"2022","unstructured":"Dalal SS, Dupree DA, Samuel AM, Reoperations after primary and revision lumbar discectomy: study of a national-level cohort with eight years follow-up. Spine J. 2022;22(12):1983\u20131989."},{"key":"b4","series-title":"World Neurosurg","first-page":"e346","article-title":"Revision discectomy with or without fusion for the treatment of recurrent lumbar disc herniation: a nationwide analysis of risk profiles and short-term outcomes","volume":"148","author":"Fuentes AM","year":"2021","unstructured":"Fuentes AM, Patil S, Chiu RG, Glastris G, Behbahani M, Mehta AI. Revision discectomy with or without fusion for the treatment of recurrent lumbar disc herniation: a nationwide analysis of risk profiles and short-term outcomes. World Neurosurg. 2021;148:e346\u2013e355."},{"issue":"12","key":"b5","series-title":"Eur Spine J","first-page":"2915","article-title":"Microdiscectomy for recurrent L5-S1 disc herniation","volume":"22","author":"Berjano P","year":"2013","unstructured":"Berjano P, Pejrona M, Damilano M. Microdiscectomy for recurrent L5-S1 disc herniation. Eur Spine J. 2013;22(12):2915\u20132917."},{"issue":"13","key":"b6","series-title":"JAMA","first-page":"1259","article-title":"Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults","volume":"303","author":"Deyo RA","year":"2010","unstructured":"Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010;303(13):1259\u20131265."},{"issue":"1","key":"b7","series-title":"J Neurosurg Spine","first-page":"48","article-title":"Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy","volume":"21","author":"Wang JC","year":"2014","unstructured":"Wang JC, Dailey AT, Mummaneni PV, Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy. J Neurosurg Spine. 2014;21(1):48\u201353."},{"issue":"19","key":"b8","series-title":"Spine (Phila Pa 1976)","first-page":"2208","article-title":"Variation in surgical decision making for degenerative spinal disorders. Part I: lumbar spine","volume":"30","author":"Irwin ZN","year":"2005","unstructured":"Irwin ZN, Hilibrand A, Gustavel M, Variation in surgical decision making for degenerative spinal disorders. Part I: lumbar spine. Spine (Phila Pa 1976). 2005;30(19):2208\u20132213."},{"issue":"8","key":"b9","series-title":"Spine (Phila Pa 1976)","first-page":"678","article-title":"Variation in outcomes across centers after surgery for lumbar stenosis and degenerative spondylolisthesis in the spine patient outcomes research trial","volume":"38","author":"Desai A","year":"2013","unstructured":"Desai A, Bekelis K, Ball PA, Variation in outcomes across centers after surgery for lumbar stenosis and degenerative spondylolisthesis in the spine patient outcomes research trial. Spine (Phila Pa 1976). 2013;38(8):678\u2013691."},{"issue":"3","key":"b10","series-title":"Spine (Phila Pa 1976)","first-page":"185","article-title":"Indication variability in degenerative lumbar spine surgery: a four-nation survey","volume":"43","author":"Debono B","year":"2018","unstructured":"Debono B, Lonjon G, Galovich LA, Indication variability in degenerative lumbar spine surgery: a four-nation survey. Spine (Phila Pa 1976). 2018;43(3):185\u2013192."},{"issue":"10","key":"b11","series-title":"Spine J","first-page":"2334","article-title":"Differences in the surgical treatment of recurrent lumbar disc herniation among spine surgeons in the United States","volume":"14","author":"Mroz TE","year":"2014","unstructured":"Mroz TE, Lubelski D, Williams SK, Differences in the surgical treatment of recurrent lumbar disc herniation among spine surgeons in the United States. Spine J. 2014;14(10):2334\u20132343."},{"issue":"10","key":"b12","series-title":"Ann Intern Med","first-page":"771","article-title":"Measuring the quality of physician practice by using clinical vignettes: a prospective validation study","volume":"141","author":"Peabody JW","year":"2004","unstructured":"Peabody JW, Luck J, Glassman P, Measuring the quality of physician practice by using clinical vignettes: a prospective validation study. Ann Intern Med. 2004;141(10):771\u2013780."},{"issue":"4","key":"b13","series-title":"J Grad Med Educ","first-page":"541","article-title":"Analyzing and interpreting data from Likert-type scales","volume":"5","author":"Sullivan GM","year":"2013","unstructured":"Sullivan GM, Artino AR Jr. Analyzing and interpreting data from Likert-type scales. J Grad Med Educ. 2013;5(4):541\u2013542."},{"issue":"6","key":"b14","series-title":"Am Sociol Rev","first-page":"850","article-title":"Measuring population diversity","volume":"34","author":"Lieberson S","year":"1969","unstructured":"Lieberson S. Measuring population diversity. Am Sociol Rev. 1969;34(6):850\u2013862."},{"issue":"1","key":"b15","series-title":"Orthop Traumatol Surg Res","first-page":"5","article-title":"Survey of French spine surgeons reveals significant variability in spine trauma practices in 2013","volume":"101","author":"Lonjon G","year":"2015","unstructured":"Lonjon G, Grelat M, Dhenin A, Survey of French spine surgeons reveals significant variability in spine trauma practices in 2013. Orthop Traumatol Surg Res. 2015;101(1):5\u201310."},{"issue":"9","key":"b16","series-title":"Neurol Med Chir (Tokyo)","first-page":"853","article-title":"Technical advancements and utilization of spine surgery","volume":"50","author":"Kim P","year":"2010","unstructured":"Kim P, Kurokawa R, Itoki K. Technical advancements and utilization of spine surgery. Neurol Med Chir (Tokyo). 2010;50(9):853\u2013858."},{"issue":"18","key":"b17","series-title":"Spine (Phila Pa 1976)","first-page":"E1104","article-title":"Mini-open anterior lumbar interbody fusion for recurrent lumbar disc herniation following posterior instrumentation","volume":"41","author":"Mamuti M","year":"2016","unstructured":"Mamuti M, Fan S, Liu J, Mini-open anterior lumbar interbody fusion for recurrent lumbar disc herniation following posterior instrumentation. Spine (Phila Pa 1976). 2016;41(18):E1104\u2013E1114."},{"issue":"11","key":"b18","series-title":"Acta Neurochir (Wien)","first-page":"3057","article-title":"How I do it: biportal endoscopic paraspinal approach for recurrent lumbar disc herniation following percutaneous endoscopic lumbar discectomy","volume":"164","author":"Park SC","year":"2022","unstructured":"Park SC, Kang MS, Yang JH, Ju W. How I do it: biportal endoscopic paraspinal approach for recurrent lumbar disc herniation following percutaneous endoscopic lumbar discectomy. Acta Neurochir (Wien). 2022;164(11):3057\u20133060."},{"issue":"3","key":"b19","series-title":"Asian J Neurosurg","first-page":"139","article-title":"Recurrent lumbar disc herniation: a prospective comparative study of three surgical management procedures","volume":"8","author":"El Shazly AA","year":"2013","unstructured":"El Shazly AA, El Wardany MA, Morsi AM. Recurrent lumbar disc herniation: a prospective comparative study of three surgical management procedures. Asian J Neurosurg. 2013;8(3):139\u2013146."},{"issue":"2","key":"b20","series-title":"Neurosurgery","first-page":"334","article-title":"Anterior lumbar microdiscectomy and interbody fusion for the treatment of recurrent disc herniation","volume":"48","author":"Vishteh AG","year":"2001","unstructured":"Vishteh AG, Dickman CA. Anterior lumbar microdiscectomy and interbody fusion for the treatment of recurrent disc herniation. Neurosurgery. 2001;48(2):334\u2013338."},{"issue":"13","key":"b21","series-title":"Spine (Phila Pa 1976)","first-page":"1473","article-title":"Outcome of revision discectomies following recurrent lumbar disc herniation","volume":"31","author":"Papadopoulos EC","year":"2006","unstructured":"Papadopoulos EC, Girardi FP, Sandhu HS, Outcome of revision discectomies following recurrent lumbar disc herniation. Spine (Phila Pa 1976). 2006;31(13):1473\u20131476."},{"issue":"5","key":"b22","series-title":"Cureus","first-page":"e622","article-title":"Treatment of recurrent disc herniation: a systematic review","volume":"8","author":"Drazin D","year":"2016","unstructured":"Drazin D, Ugiliweneza B, Al-Khouja L, Treatment of recurrent disc herniation: a systematic review. Cureus. 2016;8(5):e622."},{"key":"b23","series-title":"J Clin Neurosci","first-page":"202","article-title":"A comparison between repeat discectomy versus fusion for the treatment of recurrent lumbar disc herniation: systematic review and meta-analysis","volume":"66","author":"Tanavalee C","year":"2019","unstructured":"Tanavalee C, Limthongkul W, Yingsakmongkol W, Luksanapruksa P, Singhatanadgige W. A comparison between repeat discectomy versus fusion for the treatment of recurrent lumbar disc herniation: systematic review and meta-analysis. J Clin Neurosci. 2019;66:202\u2013208."},{"issue":"1","key":"b24","series-title":"Spine J","first-page":"180","article-title":"An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy","volume":"14","author":"Kreiner DS","year":"2014","unstructured":"Kreiner DS, Hwang SW, Easa JE, An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014;14(1):180\u2013191."},{"issue":"23","key":"b25","series-title":"Spine (Phila Pa 1976)","first-page":"2707","article-title":"United States\u2019 trends and regional variations in lumbar spine surgery: 1992-2003","volume":"31","author":"Weinstein JN","year":"2006","unstructured":"Weinstein JN, Lurie JD, Olson PR, Bronner KK, Fisher ES. United States\u2019 trends and regional variations in lumbar spine surgery: 1992-2003. Spine (Phila Pa 1976). 2006;31(23):2707\u20132714."},{"issue":"4","key":"b26","series-title":"Can J Surg","first-page":"283","article-title":"The who, what and when of surgery for the degenerative lumbar spine: a population-based study of surgeon factors, surgical procedures, recent trends and reoperation rates","volume":"52","author":"Bederman SS","year":"2009","unstructured":"Bederman SS, Kreder HJ, Weller I, Finkelstein JA, Ford MH, Yee AJM. The who, what and when of surgery for the degenerative lumbar spine: a population-based study of surgeon factors, surgical procedures, recent trends and reoperation rates. Can J Surg. 2009;52(4):283\u2013290."},{"issue":"7","key":"b27","series-title":"J Spinal Disord Tech","first-page":"477","article-title":"Agreement between orthopedic surgeons and neurosurgeons regarding a new algorithm for the treatment of thoracolumbar injuries: a multicenter reliability study","volume":"19","author":"Raja Rampersaud Y","year":"2006","unstructured":"Raja Rampersaud Y, Fisher C, Wilsey J, Agreement between orthopedic surgeons and neurosurgeons regarding a new algorithm for the treatment of thoracolumbar injuries: a multicenter reliability study. J Spinal Disord Tech. 2006;19(7):477\u2013482."},{"issue":"5","key":"b28","series-title":"Global Spine J","first-page":"498","article-title":"Spine surgeon treatment variability: the impact on costs","volume":"8","author":"Alvin MD","year":"2018","unstructured":"Alvin MD, Lubelski D, Alam R, Spine surgeon treatment variability: the impact on costs. Global Spine J. 2018;8(5):498\u2013506."},{"issue":"4","key":"b29","series-title":"J Neurosurg Spine","first-page":"349","article-title":"Editorial. Use of anterior lumbar discectomy and interbody fusion in the management of recurrent lumbar disc herniation and cauda equina syndrome","volume":"27","author":"Arnold PM","year":"2017","unstructured":"Arnold PM. Editorial. Use of anterior lumbar discectomy and interbody fusion in the management of recurrent lumbar disc herniation and cauda equina syndrome. J Neurosurg Spine. 2017;27(4):349\u2013351."},{"issue":"16","key":"b30","series-title":"Spine (Phila Pa 1976)","first-page":"E326","article-title":"Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: surgical technique, outcome, and prognostic factors of 43 consecutive cases","volume":"29","author":"Ahn Y","year":"2004","unstructured":"Ahn Y, Lee SH, Park WM, Lee HY, Shin SW, Kang HY. Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine (Phila Pa 1976). 2004;29(16):E326\u2013E332."},{"issue":"8","key":"b31","series-title":"Eur Spine J","first-page":"2647","article-title":"Bibliometric analysis and description of research trends on transforaminal full-endoscopic approach on the spine for the last two-decades","volume":"32","author":"Liu Y","year":"2023","unstructured":"Liu Y, Jitpakdee K, Van Isseldyk F, Bibliometric analysis and description of research trends on transforaminal full-endoscopic approach on the spine for the last two-decades. Eur Spine J. 2023;32(8):2647\u20132661."},{"issue":"1","key":"b32","series-title":"CMAJ","first-page":"29","article-title":"Trends in hospital use for mechanical neck and back problems in Ontario and the United States: discretionary care in different health care systems","volume":"158","author":"Lavis JN","year":"1998","unstructured":"Lavis JN, Malter A, Anderson GM, Trends in hospital use for mechanical neck and back problems in Ontario and the United States: discretionary care in different health care systems. CMAJ. 1998;158(1):29\u201336."},{"issue":"6","key":"b33","series-title":"JAMA","first-page":"595","article-title":"Physicians measure up. A study of 13 surgical procedures","volume":"245","author":"Elliott RV","year":"1981","unstructured":"Elliott RV, Kahn KA, Kaye R. Physicians measure up. A study of 13 surgical procedures. JAMA. 1981;245(6):595\u2013600."},{"issue":"9898","key":"b34","series-title":"Lancet","first-page":"1121","article-title":"Understanding of regional variation in the use of surgery","volume":"382","author":"Birkmeyer JD","year":"2013","unstructured":"Birkmeyer JD, Reames BN, McCulloch P, Carr AJ, Campbell WB, Wennberg JE. Understanding of regional variation in the use of surgery. Lancet. 2013;382(9898):1121\u20131129."},{"issue":"3","key":"b35","series-title":"Med Care","first-page":"257","article-title":"The relationship between geographic variations and overuse of healthcare services: a systematic review","volume":"50","author":"Keyhani S","year":"2012","unstructured":"Keyhani S, Falk R, Bishop T, Howell E, Korenstein D. The relationship between geographic variations and overuse of healthcare services: a systematic review. Med Care. 2012;50(3):257\u2013261."},{"issue":"2","key":"b36","series-title":"Neurospine","first-page":"389","article-title":"Are lumbar fusion guidelines followed? A survey of North American spine surgeons","volume":"18","author":"Montenegro TS","year":"2021","unstructured":"Montenegro TS, Elia C, Hines K, Are lumbar fusion guidelines followed? A survey of North American spine surgeons. Neurospine. 2021;18(2):389\u2013396."},{"issue":"5","key":"b37","series-title":"Spine J","first-page":"821","article-title":"Lumbar degenerative spondylolisthesis: factors associated with the decision to fuse","volume":"21","author":"Schneider N","year":"2021","unstructured":"Schneider N, Fisher C, Glennie A, Lumbar degenerative spondylolisthesis: factors associated with the decision to fuse. Spine J. 2021;21(5):821\u2013828."},{"issue":"10","key":"b38","series-title":"Spine J","first-page":"1586","article-title":"Recent trends in medicare utilization and reimbursement for lumbar spine fusion and discectomy procedures","volume":"20","author":"Lopez CD","year":"2020","unstructured":"Lopez CD, Boddapati V, Lombardi JM, Recent trends in medicare utilization and reimbursement for lumbar spine fusion and discectomy procedures. Spine J. 2020;20(10):1586\u20131594."},{"issue":"1","key":"b39","series-title":"Semin Spine Surg","first-page":"2","article-title":"An algorithmic approach to recurrent lumbar disk herniation: evaluation and management","volume":"20","author":"Stambough JL","year":"2008","unstructured":"Stambough JL. An algorithmic approach to recurrent lumbar disk herniation: evaluation and management. Semin Spine Surg. 2008;20(1):2\u201313."},{"issue":"9898","key":"b40","series-title":"Lancet","first-page":"1130","article-title":"Strategies to reduce variation in the use of surgery","volume":"382","author":"McCulloch P","year":"2013","unstructured":"McCulloch P, Nagendran M, Campbell WB, Strategies to reduce variation in the use of surgery. Lancet. 2013;382(9898):1130\u20131139."},{"issue":"Suppl 1","key":"b41","series-title":"Eur Spine J","first-page":"14","article-title":"Revision after failed discectomy","volume":"29","author":"Mehren C","year":"2020","unstructured":"Mehren C, Wanke-Jellinek L, Korge A. Revision after failed discectomy. Eur Spine J. 2020;29(Suppl 1):14-21."},{"issue":"14","key":"b42","series-title":"Spine (Phila Pa 1976)","first-page":"1106","article-title":"Reoperation for recurrent intervertebral disc herniation in the spine patient outcomes research trial: analysis of rate, risk factors and outcomes","volume":"42","author":"Abdu RW","year":"2017","unstructured":"Abdu RW, Abdu WA, Pearson AM, Zhao W, Lurie JD, Weinstein JN. Reoperation for recurrent intervertebral disc herniation in the spine patient outcomes research trial: analysis of rate, risk factors and outcomes. Spine (Phila Pa 1976). 2017;42(14):1106\u20131114."},{"issue":"3","key":"b43","series-title":"Global Spine J","first-page":"1533","article-title":"Repeat discectomy or instrumented surgery for recurrent lumbar disk herniation: an overview of French spine surgeons\u2019 practice","volume":"15","author":"C\u00f4mes PC","year":"2025","unstructured":"C\u00f4mes PC, Gavotto A, Zouakia Z, Repeat discectomy or instrumented surgery for recurrent lumbar disk herniation: an overview of French spine surgeons\u2019 practice. Global Spine J. 2025;15(3):1533\u20131543."},{"issue":"4","key":"b44","series-title":"Int Orthop","first-page":"1071","article-title":"Lumbar arthroplasty for treatment of primary or recurrent lumbar disc herniation","volume":"47","author":"Rossi V","year":"2023","unstructured":"Rossi V, Maalouly J, Choi JYS. Lumbar arthroplasty for treatment of primary or recurrent lumbar disc herniation. Int Orthop. 2023;47(4):1071\u20131077."},{"issue":"6","key":"b45","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Variations in cost calculations in spine surgery cost-effectiveness research","volume":"36","author":"Alvin MD","year":"2014","unstructured":"Alvin MD, Miller JA, Lubelski D, Variations in cost calculations in spine surgery cost-effectiveness research. Neurosurg Focus. 2014;36(6):E1."},{"issue":"22","key":"b1","series-title":"N Engl J Med","first-page":"2245","article-title":"Surgery versus prolonged conservative treatment for sciatica","volume":"356","author":"Peul WC","year":"2007","unstructured":"Peul WC, van Houwelingen HC, van den Hout WB, Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356(22):2245\u20132256."},{"issue":"25","key":"b2","series-title":"Spine (Phila Pa 1976)","first-page":"2147","article-title":"Asymptomatic same-site recurrent disc herniation after lumbar discectomy: results of a prospective longitudinal study with 2-year serial imaging","volume":"36","author":"Lebow RL","year":"2011","unstructured":"Lebow RL, Adogwa O, Parker SL, Sharma A, Cheng J, McGirt MJ. Asymptomatic same-site recurrent disc herniation after lumbar discectomy: results of a prospective longitudinal study with 2-year serial imaging. Spine (Phila Pa 1976). 2011;36(25):2147\u20132151."},{"issue":"12","key":"b3","series-title":"Spine J","first-page":"1983","article-title":"Reoperations after primary and revision lumbar discectomy: study of a national-level cohort with eight years follow-up","volume":"22","author":"Dalal SS","year":"2022","unstructured":"Dalal SS, Dupree DA, Samuel AM, Reoperations after primary and revision lumbar discectomy: study of a national-level cohort with eight years follow-up. Spine J. 2022;22(12):1983\u20131989."},{"key":"b4","series-title":"World Neurosurg","first-page":"e346","article-title":"Revision discectomy with or without fusion for the treatment of recurrent lumbar disc herniation: a nationwide analysis of risk profiles and short-term outcomes","volume":"148","author":"Fuentes AM","year":"2021","unstructured":"Fuentes AM, Patil S, Chiu RG, Glastris G, Behbahani M, Mehta AI. Revision discectomy with or without fusion for the treatment of recurrent lumbar disc herniation: a nationwide analysis of risk profiles and short-term outcomes. World Neurosurg. 2021;148:e346\u2013e355."},{"issue":"12","key":"b5","series-title":"Eur Spine J","first-page":"2915","article-title":"Microdiscectomy for recurrent L5-S1 disc herniation","volume":"22","author":"Berjano P","year":"2013","unstructured":"Berjano P, Pejrona M, Damilano M. Microdiscectomy for recurrent L5-S1 disc herniation. Eur Spine J. 2013;22(12):2915\u20132917."},{"issue":"13","key":"b6","series-title":"JAMA","first-page":"1259","article-title":"Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults","volume":"303","author":"Deyo RA","year":"2010","unstructured":"Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010;303(13):1259\u20131265."},{"issue":"1","key":"b7","series-title":"J Neurosurg Spine","first-page":"48","article-title":"Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy","volume":"21","author":"Wang JC","year":"2014","unstructured":"Wang JC, Dailey AT, Mummaneni PV, Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy. J Neurosurg Spine. 2014;21(1):48\u201353."},{"issue":"19","key":"b8","series-title":"Spine (Phila Pa 1976)","first-page":"2208","article-title":"Variation in surgical decision making for degenerative spinal disorders. Part I: lumbar spine","volume":"30","author":"Irwin ZN","year":"2005","unstructured":"Irwin ZN, Hilibrand A, Gustavel M, Variation in surgical decision making for degenerative spinal disorders. Part I: lumbar spine. Spine (Phila Pa 1976). 2005;30(19):2208\u20132213."},{"issue":"8","key":"b9","series-title":"Spine (Phila Pa 1976)","first-page":"678","article-title":"Variation in outcomes across centers after surgery for lumbar stenosis and degenerative spondylolisthesis in the spine patient outcomes research trial","volume":"38","author":"Desai A","year":"2013","unstructured":"Desai A, Bekelis K, Ball PA, Variation in outcomes across centers after surgery for lumbar stenosis and degenerative spondylolisthesis in the spine patient outcomes research trial. Spine (Phila Pa 1976). 2013;38(8):678\u2013691."},{"issue":"3","key":"b10","series-title":"Spine (Phila Pa 1976)","first-page":"185","article-title":"Indication variability in degenerative lumbar spine surgery: a four-nation survey","volume":"43","author":"Debono B","year":"2018","unstructured":"Debono B, Lonjon G, Galovich LA, Indication variability in degenerative lumbar spine surgery: a four-nation survey. Spine (Phila Pa 1976). 2018;43(3):185\u2013192."},{"issue":"10","key":"b11","series-title":"Spine J","first-page":"2334","article-title":"Differences in the surgical treatment of recurrent lumbar disc herniation among spine surgeons in the United States","volume":"14","author":"Mroz TE","year":"2014","unstructured":"Mroz TE, Lubelski D, Williams SK, Differences in the surgical treatment of recurrent lumbar disc herniation among spine surgeons in the United States. Spine J. 2014;14(10):2334\u20132343."},{"issue":"10","key":"b12","series-title":"Ann Intern Med","first-page":"771","article-title":"Measuring the quality of physician practice by using clinical vignettes: a prospective validation study","volume":"141","author":"Peabody JW","year":"2004","unstructured":"Peabody JW, Luck J, Glassman P, Measuring the quality of physician practice by using clinical vignettes: a prospective validation study. Ann Intern Med. 2004;141(10):771\u2013780."},{"issue":"4","key":"b13","series-title":"J Grad Med Educ","first-page":"541","article-title":"Analyzing and interpreting data from Likert-type scales","volume":"5","author":"Sullivan GM","year":"2013","unstructured":"Sullivan GM, Artino AR Jr. Analyzing and interpreting data from Likert-type scales. J Grad Med Educ. 2013;5(4):541\u2013542."},{"issue":"6","key":"b14","series-title":"Am Sociol Rev","first-page":"850","article-title":"Measuring population diversity","volume":"34","author":"Lieberson S","year":"1969","unstructured":"Lieberson S. Measuring population diversity. Am Sociol Rev. 1969;34(6):850\u2013862."},{"issue":"1","key":"b15","series-title":"Orthop Traumatol Surg Res","first-page":"5","article-title":"Survey of French spine surgeons reveals significant variability in spine trauma practices in 2013","volume":"101","author":"Lonjon G","year":"2015","unstructured":"Lonjon G, Grelat M, Dhenin A, Survey of French spine surgeons reveals significant variability in spine trauma practices in 2013. Orthop Traumatol Surg Res. 2015;101(1):5\u201310."},{"issue":"9","key":"b16","series-title":"Neurol Med Chir (Tokyo)","first-page":"853","article-title":"Technical advancements and utilization of spine surgery","volume":"50","author":"Kim P","year":"2010","unstructured":"Kim P, Kurokawa R, Itoki K. Technical advancements and utilization of spine surgery. Neurol Med Chir (Tokyo). 2010;50(9):853\u2013858."},{"issue":"18","key":"b17","series-title":"Spine (Phila Pa 1976)","first-page":"E1104","article-title":"Mini-open anterior lumbar interbody fusion for recurrent lumbar disc herniation following posterior instrumentation","volume":"41","author":"Mamuti M","year":"2016","unstructured":"Mamuti M, Fan S, Liu J, Mini-open anterior lumbar interbody fusion for recurrent lumbar disc herniation following posterior instrumentation. Spine (Phila Pa 1976). 2016;41(18):E1104\u2013E1114."},{"issue":"11","key":"b18","series-title":"Acta Neurochir (Wien)","first-page":"3057","article-title":"How I do it: biportal endoscopic paraspinal approach for recurrent lumbar disc herniation following percutaneous endoscopic lumbar discectomy","volume":"164","author":"Park SC","year":"2022","unstructured":"Park SC, Kang MS, Yang JH, Ju W. How I do it: biportal endoscopic paraspinal approach for recurrent lumbar disc herniation following percutaneous endoscopic lumbar discectomy. Acta Neurochir (Wien). 2022;164(11):3057\u20133060."},{"issue":"3","key":"b19","series-title":"Asian J Neurosurg","first-page":"139","article-title":"Recurrent lumbar disc herniation: a prospective comparative study of three surgical management procedures","volume":"8","author":"El Shazly AA","year":"2013","unstructured":"El Shazly AA, El Wardany MA, Morsi AM. Recurrent lumbar disc herniation: a prospective comparative study of three surgical management procedures. Asian J Neurosurg. 2013;8(3):139\u2013146."},{"issue":"2","key":"b20","series-title":"Neurosurgery","first-page":"334","article-title":"Anterior lumbar microdiscectomy and interbody fusion for the treatment of recurrent disc herniation","volume":"48","author":"Vishteh AG","year":"2001","unstructured":"Vishteh AG, Dickman CA. Anterior lumbar microdiscectomy and interbody fusion for the treatment of recurrent disc herniation. Neurosurgery. 2001;48(2):334\u2013338."},{"issue":"13","key":"b21","series-title":"Spine (Phila Pa 1976)","first-page":"1473","article-title":"Outcome of revision discectomies following recurrent lumbar disc herniation","volume":"31","author":"Papadopoulos EC","year":"2006","unstructured":"Papadopoulos EC, Girardi FP, Sandhu HS, Outcome of revision discectomies following recurrent lumbar disc herniation. Spine (Phila Pa 1976). 2006;31(13):1473\u20131476."},{"issue":"5","key":"b22","series-title":"Cureus","first-page":"e622","article-title":"Treatment of recurrent disc herniation: a systematic review","volume":"8","author":"Drazin D","year":"2016","unstructured":"Drazin D, Ugiliweneza B, Al-Khouja L, Treatment of recurrent disc herniation: a systematic review. Cureus. 2016;8(5):e622."},{"key":"b23","series-title":"J Clin Neurosci","first-page":"202","article-title":"A comparison between repeat discectomy versus fusion for the treatment of recurrent lumbar disc herniation: systematic review and meta-analysis","volume":"66","author":"Tanavalee C","year":"2019","unstructured":"Tanavalee C, Limthongkul W, Yingsakmongkol W, Luksanapruksa P, Singhatanadgige W. A comparison between repeat discectomy versus fusion for the treatment of recurrent lumbar disc herniation: systematic review and meta-analysis. J Clin Neurosci. 2019;66:202\u2013208."},{"issue":"1","key":"b24","series-title":"Spine J","first-page":"180","article-title":"An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy","volume":"14","author":"Kreiner DS","year":"2014","unstructured":"Kreiner DS, Hwang SW, Easa JE, An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014;14(1):180\u2013191."},{"issue":"23","key":"b25","series-title":"Spine (Phila Pa 1976)","first-page":"2707","article-title":"United States\u2019 trends and regional variations in lumbar spine surgery: 1992-2003","volume":"31","author":"Weinstein JN","year":"2006","unstructured":"Weinstein JN, Lurie JD, Olson PR, Bronner KK, Fisher ES. United States\u2019 trends and regional variations in lumbar spine surgery: 1992-2003. Spine (Phila Pa 1976). 2006;31(23):2707\u20132714."},{"issue":"4","key":"b26","series-title":"Can J Surg","first-page":"283","article-title":"The who, what and when of surgery for the degenerative lumbar spine: a population-based study of surgeon factors, surgical procedures, recent trends and reoperation rates","volume":"52","author":"Bederman SS","year":"2009","unstructured":"Bederman SS, Kreder HJ, Weller I, Finkelstein JA, Ford MH, Yee AJM. The who, what and when of surgery for the degenerative lumbar spine: a population-based study of surgeon factors, surgical procedures, recent trends and reoperation rates. Can J Surg. 2009;52(4):283\u2013290."},{"issue":"7","key":"b27","series-title":"J Spinal Disord Tech","first-page":"477","article-title":"Agreement between orthopedic surgeons and neurosurgeons regarding a new algorithm for the treatment of thoracolumbar injuries: a multicenter reliability study","volume":"19","author":"Raja Rampersaud Y","year":"2006","unstructured":"Raja Rampersaud Y, Fisher C, Wilsey J, Agreement between orthopedic surgeons and neurosurgeons regarding a new algorithm for the treatment of thoracolumbar injuries: a multicenter reliability study. J Spinal Disord Tech. 2006;19(7):477\u2013482."},{"issue":"5","key":"b28","series-title":"Global Spine J","first-page":"498","article-title":"Spine surgeon treatment variability: the impact on costs","volume":"8","author":"Alvin MD","year":"2018","unstructured":"Alvin MD, Lubelski D, Alam R, Spine surgeon treatment variability: the impact on costs. Global Spine J. 2018;8(5):498\u2013506."},{"issue":"4","key":"b29","series-title":"J Neurosurg Spine","first-page":"349","article-title":"Editorial. Use of anterior lumbar discectomy and interbody fusion in the management of recurrent lumbar disc herniation and cauda equina syndrome","volume":"27","author":"Arnold PM","year":"2017","unstructured":"Arnold PM. Editorial. Use of anterior lumbar discectomy and interbody fusion in the management of recurrent lumbar disc herniation and cauda equina syndrome. J Neurosurg Spine. 2017;27(4):349\u2013351."},{"issue":"16","key":"b30","series-title":"Spine (Phila Pa 1976)","first-page":"E326","article-title":"Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: surgical technique, outcome, and prognostic factors of 43 consecutive cases","volume":"29","author":"Ahn Y","year":"2004","unstructured":"Ahn Y, Lee SH, Park WM, Lee HY, Shin SW, Kang HY. Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine (Phila Pa 1976). 2004;29(16):E326\u2013E332."},{"issue":"8","key":"b31","series-title":"Eur Spine J","first-page":"2647","article-title":"Bibliometric analysis and description of research trends on transforaminal full-endoscopic approach on the spine for the last two-decades","volume":"32","author":"Liu Y","year":"2023","unstructured":"Liu Y, Jitpakdee K, Van Isseldyk F, Bibliometric analysis and description of research trends on transforaminal full-endoscopic approach on the spine for the last two-decades. Eur Spine J. 2023;32(8):2647\u20132661."},{"issue":"1","key":"b32","series-title":"CMAJ","first-page":"29","article-title":"Trends in hospital use for mechanical neck and back problems in Ontario and the United States: discretionary care in different health care systems","volume":"158","author":"Lavis JN","year":"1998","unstructured":"Lavis JN, Malter A, Anderson GM, Trends in hospital use for mechanical neck and back problems in Ontario and the United States: discretionary care in different health care systems. CMAJ. 1998;158(1):29\u201336."},{"issue":"6","key":"b33","series-title":"JAMA","first-page":"595","article-title":"Physicians measure up. A study of 13 surgical procedures","volume":"245","author":"Elliott RV","year":"1981","unstructured":"Elliott RV, Kahn KA, Kaye R. Physicians measure up. A study of 13 surgical procedures. JAMA. 1981;245(6):595\u2013600."},{"issue":"9898","key":"b34","series-title":"Lancet","first-page":"1121","article-title":"Understanding of regional variation in the use of surgery","volume":"382","author":"Birkmeyer JD","year":"2013","unstructured":"Birkmeyer JD, Reames BN, McCulloch P, Carr AJ, Campbell WB, Wennberg JE. Understanding of regional variation in the use of surgery. Lancet. 2013;382(9898):1121\u20131129."},{"issue":"3","key":"b35","series-title":"Med Care","first-page":"257","article-title":"The relationship between geographic variations and overuse of healthcare services: a systematic review","volume":"50","author":"Keyhani S","year":"2012","unstructured":"Keyhani S, Falk R, Bishop T, Howell E, Korenstein D. The relationship between geographic variations and overuse of healthcare services: a systematic review. Med Care. 2012;50(3):257\u2013261."},{"issue":"2","key":"b36","series-title":"Neurospine","first-page":"389","article-title":"Are lumbar fusion guidelines followed? A survey of North American spine surgeons","volume":"18","author":"Montenegro TS","year":"2021","unstructured":"Montenegro TS, Elia C, Hines K, Are lumbar fusion guidelines followed? A survey of North American spine surgeons. Neurospine. 2021;18(2):389\u2013396."},{"issue":"5","key":"b37","series-title":"Spine J","first-page":"821","article-title":"Lumbar degenerative spondylolisthesis: factors associated with the decision to fuse","volume":"21","author":"Schneider N","year":"2021","unstructured":"Schneider N, Fisher C, Glennie A, Lumbar degenerative spondylolisthesis: factors associated with the decision to fuse. Spine J. 2021;21(5):821\u2013828."},{"issue":"10","key":"b38","series-title":"Spine J","first-page":"1586","article-title":"Recent trends in medicare utilization and reimbursement for lumbar spine fusion and discectomy procedures","volume":"20","author":"Lopez CD","year":"2020","unstructured":"Lopez CD, Boddapati V, Lombardi JM, Recent trends in medicare utilization and reimbursement for lumbar spine fusion and discectomy procedures. Spine J. 2020;20(10):1586\u20131594."},{"issue":"1","key":"b39","series-title":"Semin Spine Surg","first-page":"2","article-title":"An algorithmic approach to recurrent lumbar disk herniation: evaluation and management","volume":"20","author":"Stambough JL","year":"2008","unstructured":"Stambough JL. An algorithmic approach to recurrent lumbar disk herniation: evaluation and management. Semin Spine Surg. 2008;20(1):2\u201313."},{"issue":"9898","key":"b40","series-title":"Lancet","first-page":"1130","article-title":"Strategies to reduce variation in the use of surgery","volume":"382","author":"McCulloch P","year":"2013","unstructured":"McCulloch P, Nagendran M, Campbell WB, Strategies to reduce variation in the use of surgery. Lancet. 2013;382(9898):1130\u20131139."},{"issue":"Suppl 1","key":"b41","series-title":"Eur Spine J","first-page":"14","article-title":"Revision after failed discectomy","volume":"29","author":"Mehren C","year":"2020","unstructured":"Mehren C, Wanke-Jellinek L, Korge A. Revision after failed discectomy. Eur Spine J. 2020;29(Suppl 1):14-21."},{"issue":"14","key":"b42","series-title":"Spine (Phila Pa 1976)","first-page":"1106","article-title":"Reoperation for recurrent intervertebral disc herniation in the spine patient outcomes research trial: analysis of rate, risk factors and outcomes","volume":"42","author":"Abdu RW","year":"2017","unstructured":"Abdu RW, Abdu WA, Pearson AM, Zhao W, Lurie JD, Weinstein JN. Reoperation for recurrent intervertebral disc herniation in the spine patient outcomes research trial: analysis of rate, risk factors and outcomes. Spine (Phila Pa 1976). 2017;42(14):1106\u20131114."},{"issue":"3","key":"b43","series-title":"Global Spine J","first-page":"1533","article-title":"Repeat discectomy or instrumented surgery for recurrent lumbar disk herniation: an overview of French spine surgeons\u2019 practice","volume":"15","author":"C\u00f4mes PC","year":"2025","unstructured":"C\u00f4mes PC, Gavotto A, Zouakia Z, Repeat discectomy or instrumented surgery for recurrent lumbar disk herniation: an overview of French spine surgeons\u2019 practice. Global Spine J. 2025;15(3):1533\u20131543."},{"issue":"4","key":"b44","series-title":"Int Orthop","first-page":"1071","article-title":"Lumbar arthroplasty for treatment of primary or recurrent lumbar disc herniation","volume":"47","author":"Rossi V","year":"2023","unstructured":"Rossi V, Maalouly J, Choi JYS. Lumbar arthroplasty for treatment of primary or recurrent lumbar disc herniation. Int Orthop. 2023;47(4):1071\u20131077."},{"issue":"6","key":"b45","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Variations in cost calculations in spine surgery cost-effectiveness research","volume":"36","author":"Alvin MD","year":"2014","unstructured":"Alvin MD, Miller JA, Lubelski D, Variations in cost calculations in spine surgery cost-effectiveness research. Neurosurg Focus. 2014;36(6):E1."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/43\/6\/article-p681.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/43\/6\/article-p681.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/43\/6\/article-p681.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T13:44:43Z","timestamp":1772804683000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/43\/6\/article-p681.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,5]]},"references-count":90,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2025.4.spine24303","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2025,9,5]]}}}