Surgical decision making and relationship of preoperative planning with preoperative procedures in lumbar degenerative disease and spinal stenosis

Surgical treatment methods can be the preferred method of choice after failed conservative treatment in lumbar degenerative diseases according to patient?s clinical and radiographic findings.However,both diverse surgical methods described for lumbar degenerative diseases and many parameters used for preoperative planning may cause wide differences between planned and performed surgical procedures during the operations.This study was planned to statistically delineate,for the first time,the possible differences between preoperative planning and performed procedures during the operation and to describe the parameters causing these differences.In this study,four spine surgeons were asked to complete a questionnaire containing 162 questions for preoperative planning for 16 patients operated for lumbar degenerative disease. Consistency between preoperative planned and preoperative performed procedures were calculated.First,overall kappa consistency were calculated for all surgical levels and all procedures and found to be high consistency.High consistency was also found for discectomy, laminectomy,excision of flavum,and posterior spinal instrumentation.Consistency was moderate for foraminotomy and foraminectomy.Preoperative clinical findings of radiculopathy and claudication were found to have no relationship with surgical planning, whereas magnetic resonance finding of vertebral stenosis was found to have a high relationship with preoperative planning.When consistency for different lumbar levels were calculated, L5-S1 leve was found to be least consistent level.As a result,differences among preoperative planned and peroperative performed procedures were found for lumbar degenerative disease surgery.These differences were significant for foraminotomy, foraminectomy and L5-S1 level.