Carolina Breuning , Xinggui Tian , Jens Goronzy , Klaus-Peter Günther , Uwe Platza, Franziska Beyer , Alexander C. Disch, Paul F. Lachiewicz , Ning Liu , Stuart B. Goodman , Kirkham B. Wood , Stefan Zwingenberger
Purpose: The aim of this study was to investigate the preferences and rationale for the sequence of surgical treatment of different hip-spine syndrome scenarios among potentially interviewed specialists. Methods: A questionnaire survey was administered to German hip and spine surgeons regarding their preferred surgical sequence and treatment rationale for five fictional clinical presentations of hip-spine syndrome. The scenarios included symptomatic hip osteoarthritis and: 1) lumbar spinal stenosis with neurological claudication, 2) lumbar degenerative spondylolisthesis with leg pain, 3) lumbar disc herniation with leg weakness, 4) lumbar scoliosis with back pain, and 5) thoracolumbar disc herniation with myelopathy. A further cross-nation comparison of the German findings was made with the previous same questionnaire conducted in the United States. Results: German hip and spine surgeons demonstrated a surgical order preference paradigm characterized by prioritizing spine-first for spinal disease with neurological deficits (scenario1, 3, 5), otherwise hip-first preferred without neurological deficits (scenario 2, 4). US surgeons had different patterns of surgical order preference, consistent with German surgeons in some scenarios and not in others. There was also a certain tendency of surgical order preference in different specialists. The surgeons’ preference decision was primarily influenced by the severity and time urgency of symptoms, spine-pelvis-hip biomechanics, and ease and therapeutic effect of hip and spine surgery. Conclusions: The sequence of hip and spine surgery in different hip-spine syndrome scenarios has different preference patterns, with professional preferences and cross-nation differences, affected by many factors including disease and treatment regimen.