Regional variability and economic impact on surgical practices for metastatic spinal disease in Europe – a survey on spine surgeons

Purpose: We expect variability in the management of metastatic spinal disease, potentially stemming from financial disparities. This survey-based study sought to determine the current state of surgical practices for metastatic spinal disease (MSD) in Europe. Methods: An anonymous survey was distributed to the European AO Spine members. The first part of the survey explored basic characteristics of the respondents and their institutions. The second part consisted of clinical case scenarios. Responses were compared between geographical regions (North, West, East, South) and economic tertiles after classifying the respondents’ countries per their gross national income (GNI) using the chi-squared test and logistic regression. Results: 199 surgeons completed the survey. Most were employed in academic institutions (57%) with an experience of over 5 years (89%). GNI was associated with the resources available but little with preoperative or surgical practices. Neurologic deficits were the most common surgical indication in the North (79%) and East (55%), whereas symptomatic or impending instability was most common in the West (53%) and South (52%), p = 0.007. Surgeons were more likely to use the separation surgery concept in the Eastern and Southern regions (51% and 53%) than in the Northern or Western regions (20% and 25%), p = 0.006. Conclusions: Geographical variability was observed in willingness to and timing of surgery in MSD. The economic status of countries had a little impact on practices, while it impacted the resources available. Results highlight the need for continued, evidence-based education and guidelines.