Background:

Instrumented fusion procedures are essential in the treatment of degenerative lumbar spine disease to alleviate pain and improve neurologic function, but are being performed with increasing incidence and variability.

Objective:

We implemented a training module for neurosurgery residents that is based on evidence-based criteria for lumbar fusion surgery and measured its effectiveness in the residents’ decision making regarding whether patients should or should not undergo instrumented fusion.

Methods:

The study design is a pretest versus posttest experiment conducted from September 2019 until July 2020 to measure improvement after formalized instruction on evidence-based guidelines. Neurosurgery resident physicians of all training levels at our institution participated and a test was administered at the beginning of each academic year. The highest possible score was 18 points in each pretest and posttest.

Results:

The participation rate is 79.2% (19/24). There was a general trend of test score improvement across all levels of training with a greater degree of change for those with a lower compared to higher pretest scores, indicating a possible ceiling effect. Paired t-test demonstrated an overall mean score increase of 2 points (p<0.0001), equivalent to an 11.11%-increase (p<0.0001). Stratified by training group, the mean absolute change in test score was 2 (p=0.0217), 1.67 (p=0.0108), and 2.25 (p=0.0173) points for the junior, midlevel, and senior training groups, respectively.

Conclusions:

The authors demonstrate that incorporating a targeted evidence-based learning module for lumbar spine fusion surgery can improve neurosurgery residents’ clinical decision-making toward a more uniform practice supported by published data.