Poster Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Introduction. Spine surgery is a complex and challenging field that requires careful decision-making and planning. This study employed a collective intelligence approach to assess how cooperation and discussion among physicians affect the decision about the treatment pathway, and if it may have a potentially beneficial effect in terms of treatment outcome.

Methods. An anonymized database containing imaging of the lumbar spine (MRI, radiographs) as well as clinical data of 135 patients (41 males and 94 females, age range: 25-88 years) with lumbar degenerative disorders (spondylolisthesis, disc herniation, stenosis, disc degeneration) was created by extracting data from the institutional spine registry. Six experienced spine surgeons and three non-surgical spine specialists analyzed each case and estimated two indexes describing the concordance between symptoms and radiological imaging, and the expected improvement after the treatment, and recommended either a surgical or a conservative pathway. After a group discussion of the case, the assessment was repeated and compared with the previous one.

Results. The two indexes were strongly correlated with the choice of the treatment pathway but not with the treatment outcome (12-months COMI). More surgeries were indicated for patients with higher expected improvement and higher concordance between imaging and symptoms. In general, the group discussion had limited impact on the results; the observers did not change their opinion about the treatment pathway after the group discussion in 93% of the cases (Figure).

Discussion. Group discussions were ineffective in modifying the original treatment recommendation. While collective intelligence may have a role for spine patients, an approach based on independent raters and a majority or quorum criterion may be sufficient.

Figure caption. Changes in the preferred treatment pathway between the first and the second rounds of assessments. “surg. (unchanged)”: the observer indicated a surgical pathway both in the first and in the second round; “cons. (unchanged)”: conservative pathway in both rounds; “surg. to cons.”: surgical pathway in the first round, conservative in the second; “cons. to surg.”: conservative pathway in the first round, surgical in the second.