Impact of resident versus specialist performed cervical spine surgery

Cervical spine surgeries are complex procedures associated with a significant risk of suboptimal clinical outcomes. In Denmark, residents perform cervical spine surgery under specialist supervision during their training. This study aims to assess whether patient-reported outcomes (PROs) differ between cervical spine surgeries performed by supervised residents and those performed by specialist neurosurgeons.

To compare PROs following cervical spine surgeries performed by residents versus specialist neurosurgeons.

Data from 464 surgical decompressive procedures performed at Aarhus University Hospital between 2018 and 2023 were extracted from the national spine surgery database, DaneSpine. Univariate and multivariate ordinal and binary logistic regression were performed to calculate odds ratios (OR) for lower arm and neck pain (visual analogue scale), lower neck disability index (NDI), and patient satisfaction at 1-year follow-up. Specialist neurosurgeons served as the reference group.

Multivariate ordinal and logistic regressions found no statistically significant difference in PROs between the groups. At 1-year follow-up, we find a tendency towards patients with resident-performed surgery having a better chance of improvements for arm pain (OR 1.05, CI = 0.69-1.58), however a lower chance of improvement for neck pain (OR 0.93, CI = 0.63-1.39), NDI (OR = 0.80, CI = 0.49-1.31) and being satisfied (OR = 0.89, CI = 0.55-1.46).

Our results support the practice of graduated surgical responsibility: with proper supervision and case selection, resident surgeons can safely participate in cervical spine surgeries without significantly affecting patient-reported outcomes.