Background: Endoscopically visualized spine surgery has become an essential tool that aids in identifying and treating anatomical spine pathologies that are not well demonstrated by traditional advanced imaging, including MRI. These pathologies may be visualized during endoscopic lumbar decompression (ELD) and categorized into primary pain generators (PPG). Identifying these PPGs provides crucial information for a successful outcome with ELD and forms the basis for our proposed personalized spine care protocol (SpineScreen). Methods: a prospective study of 412 patients from 7 endoscopic practices consisting of 207 (50.2%) males and 205 (49.8%) females with an average age of 63.67 years and an average follow-up of 69.27 months was performed to compare the durability of targeted ELD based on validated primary pain generators versus image-based open lumbar laminectomy, and minimally invasive lumbar transforaminal interbody fusion (TLIF) using Kaplan-Meier median survival calculations. The serial time was determined as the interval between index surgery and when patients were censored for additional interventional and surgical treatments for low back-related symptoms. A control group was recruited from patients referred for a surgical consultation but declined interventional and surgical treatment and continued on medical care. Control group patients were censored when they crossed over into any surgical or interventional treatment group.
Conclusions: SpineScreen describes a multifaceted methodology that aims to provide personalized, targeted spine care. This care model is an alternative to traditional image-based necessity criteria for spinal surgery. The degenerative spine disease is often poorly managed in its initial stages and only treated definitively in its end stages, where reconstructive decompression fusions are often the only reasonable option. As routinely done in managing other chronic diseases, the authors propose using their staged management style for earlier intervention in painful spine disease to treat the large group of patients that are currently unattended yet seek help from other physicians providing chiropractic homeopathic and pain management care. The high utilization in these other subspecialties and the high cost of end-stage traditional surgical spine care associated with a higher reoperation rate warrant additional research to determine whether the authors’ personalized spine care model focused on a more targeted approach to the patients’ predominant pain generator can be applied to the primary care setting or to larger referral centers and specialty clinics where follow through on the complex SpineScreen protocol may be less practical due to high staff turnover or variations in surgeon skill level. At a minimum, the authors demonstrated that different postoperative performance characteristics between the investigated lumbar surgeries exist, and they may impact the outcome and indirectly cost.