Survey: Spine surgeons have insufficient anatomy knowledge related to foot drop

Spine surgeons at academic institutions gave more correct answers than surgeons in other practice settings.

Spine surgeons worldwide showed they had similar knowledge of the musculoskeletal anatomy, neuro anatomy and neurophysiology of the L5 nerve root and the peroneal nerve, but this knowledge was less than sufficient for them to perform an adequate assessment of foot drop, according to results of a survey-based study.

Among the 6,231 members of the AO Spine network to whom Ravichandra Madineni, MD, and colleagues sent an Internet-based survey on the topic of foot drop assessment, 72% (464 surgeons) responded and completed all nine questions.

Findings showed 14 respondents, or 3% of the surgeons who replied to the survey, answered all the anatomy questions correctly.

Better knowledge, training needed

The results led the researchers to conclude there may be an overall lack of knowledge among spine surgeons of the lumbosacral plexus and lower extremity anatomy.

“The hope should be for resident training to focus on the diagnosis of patients with foot drop,” Madineni said when he presented these findings at the Congress of Neurological Surgeons Annual Meeting.

He told Spine Surgery Today, “There is a lack of focused learning during the training years. Residency years in both orthopedic and neurosurgery specialties includes anatomy and clinical training, but we fail to apply that knowledge in a particular clinical setting.”

Variety of questions asked

The researchers’ objective was to determine how well L5 radiculopathy or other etiologies of foot drop were differentiated by practicing spine surgeons, as treatment strategies for foot drop differ by whether peroneal neuropathy or L5 radiculopathy is its cause.

Foot drop due to L5 radiculopathy is mainly treated with L5 nerve root decompression via laminectomy, discectomy or spine fusion, according to Madineni. If peroneal neuropathy is the cause, the “problem lies along the course of the nerve in the lower limb,” he told Spine Surgery Today. Treatment would consist of decompression of the peroneal nerve through neurolysis, transposition or nerve repair done with a graft, Madineni said.

“I think the weakest point in anatomical knowledge was found in muscles innervated by the L5 nerve root,” he told Spine Surgery Today.

In addition to the anatomy questions, the survey Madineni and colleagues used asked about the practice setting, number of years in practice, geographic location of the practice and the type of training the physician received.

“We had close to 50% of them come from academic backgrounds and the rest, 50%, were non-academic, with different forms of practice,” Madineni said.

Academic setting impacts results

Ultimately, 229 surgeons in academic institutions answered 51% of the questions correctly compared to 235 surgeons in all other practice settings who answered 44% of the questions correctly.

The region of the world in which the respondents practiced appeared to have no effect on the surgeons’ ability to answer the survey questions correctly, according to the study abstract.

“All of us go through the same kind of learning and are taught to differentiate these kinds of tricky clinical conditions based on clinical examination or diagnostic studies,” Madineni told Spine Surgery Today. “There has to be consensus or guidelines among the spine surgeons all around the world on how to evaluate a patient with foot drop. This should be a short and focused assessment that can be applied in day-to-day clinical practice,” he said.

The spine surgeons surveyed had between 1 year and 20 years of experience. – by Susan M. Rapp

Reference:
Maulucci AM, et al. Paper #102. Presented at: Congress of Neurological Surgeons Annual Meeting; Sept. 26-30, 2015. New Orleans.

For more information:

Ravichandra Madineni, MD, can be reached in the Department of Neurological Surgery, Thomas Jefferson University, 909 Walnut St. Philadelphia, PA 19107; email: rmadineni@yahoo.com.

Disclosure: Madineni reports no relevant financial disclosures.