Second opinion in spine surgery: A scoping review

Area of Science:

• Spine Surgery
• Medical Decision Making
• Health Economics

Background:

• Increasingly complex and costly spinal surgeries necessitate evaluating the role of second opinions (SOs).
• Previous studies on the value and impact of SOs before spine surgery have limitations.
• This review focuses on the shortcomings of 14 studies concerning SOs in spine surgery.

Purpose of the Study:

• To summarize and analyze the existing literature on the role and value of second opinions (SOs) prior to spine surgery.
• To identify the shortcomings in current research regarding SOs in the context of spinal procedures.
• To highlight the clinical and economic implications of seeking SOs for spine surgery.

Main Methods:

• A systematic literature search was conducted using PubMed, Google Scholar, and Scopus.
• Included studies were published in English, were primary articles, and dated within the last 20 years.
• A total of 14 studies met the inclusion criteria for this review.

Main Results:

• Approximately 40.6% of initial spine consultations involved a second opinion (SO).
• A significant 61.3% of patients received a discordant SO, meaning it differed from the initial recommendation.
• Of the discordant SOs, 75% advised conservative management over surgical intervention.
• Discordance in SOs was observed across a variety of spinal surgical procedures.

Conclusions:

• Half of the second opinions (SOs) in spine surgery studies differed from the initial consultation's advice.
• SOs can significantly influence patient care decisions in spine surgery.
• Prospective studies are crucial to assess the impact of following first versus second opinions to potentially optimize surgical care.