BACKGROUND Regional differences in acceptance and utilization of MISST by spine surgeons may have an impact on clinical decision-making and the surgical treatment of common degenerative conditions of the lumbar spine. The purpose of this study was to analyze the acceptance and utilization of various minimally invasive spinal surgery techniques (MISST) by spinal surgeons the world over. METHODS The authors solicited responses to an online survey sent to spine surgeons by email, and chat groups in social media networks including Facebook, WeChat, WhatsApp, and Linkedin. Surgeons were asked the following questions: (I) Do you think minimally invasive spinal surgery is considered mainstream in your area and practice setting? (II) Do you perform minimally invasive spinal surgery? (III) What type of MIS spinal surgery do you perform? (IV) If you are performing endoscopic spinal decompression surgeries, which approach do you prefer? The responses were cross-tabulated by surgeons' demographic data, and their practice area using the following five global regions: Africa & Middle East, Asia, Europe, North America, and South America. Pearson Chi-Square measures, Kappa statistics, and linear regression analysis of agreement or disagreement were performed by analyzing the distribution of variances using statistical package SPSS Version 25.0. RESULTS A total of 586 surgeons accessed the survey. Analyzing the responses of 292 submitted surveys regional differences in opinion amongst spine surgeons showed that the highest percentage of surgeons in Asia (72.8%) and South America (70.2%) thought that MISST was accepted into mainstream spinal surgery in their practice area (P=0.04) versus North America (62.8%), Europe (52.8%), and Africa & Middle East region (50%). The percentage of spine surgeons employing MISST was much higher per region than the rate of surgeons who thought it was mainstream: Asia (96.7%), Europe (88.9%), South America (88.9%), and Africa & Middle East (87.5%). Surgeons in North America reported the lowest rate of MISST implementation globally (P<0.000). Spinal endoscopy (59.9%) is currently the most commonly employed MISST globally followed by mini-open approaches (55.1%), and tubular retractor systems (41.8%). The most preferred endoscopic approach to the spine is the transforaminal technique (56.2%) followed by interlaminar (41.8%), full endoscopic (35.3%), and over the top MISST (13.7%). CONCLUSIONS The rate of implementation of MISST into day-to-day clinical practice reported by spine surgeons was universally higher than the perceived acceptance rates of MISST into the mainstream by their peers in their practice area. The survey suggests that endoscopic spinal surgery is now the most commonly performed MISST.

中文翻译：

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脊柱外科医生接受和利用微创脊柱手术技术的地区差异：一项全球调查的结果。

背景脊柱外科医生对 MISST 的接受和使用的地区差异可能会影响临床决策和腰椎常见退行性疾病的手术治疗。本研究的目的是分析世界各地的脊柱外科医生对各种微创脊柱手术技术 (MISST) 的接受和利用情况。方法 作者通过电子邮件和社交媒体网络（包括 Facebook、微信、WhatsApp 和 Linkedin）中的聊天组向脊柱外科医生发送在线调查，征求回复。外科医生被问到以下问题：(I) 您认为微创脊柱手术在您所在的地区和实践环境中被认为是主流吗？（二）您是否进行脊柱微创手术？(III) 您进行哪种类型的 MIS 脊柱手术？（四）如果您是做内镜下脊椎减压手术，您更喜欢哪种方式？外科医生的人口统计数据和他们的执业领域使用以下五个全球区域对这些回答进行了交叉制表：非洲和中东、亚洲、欧洲、北美和南美。通过使用统计软件包 SPSS 25.0 版分析方差分布，进行 Pearson 卡方测量、Kappa 统计和一致或不一致的线性回归分析。结果 共有 586 名外科医生参与了调查。分析 292 份提交的调查的回应，脊柱外科医生的地区意见差异表明，亚洲（72.8%）和南美洲（70.2%）的最高比例的外科医生认为 MISST 被接受为他们执业领域的主流脊柱手术（P= 0.04) 与北美 (62.8%)、欧洲 (52.8%) 以及非洲和中东地区 (50%)。每个地区使用 MISST 的脊柱外科医生的比例远高于认为它是主流的外科医生的比例：亚洲 (96.7%)、欧洲 (88.9%)、南美 (88.9%) 以及非洲和中东 (87.5%) ）。北美外科医生报告的全球 MISST 实施率最低（P<0.000）。脊柱内窥镜检查（59.9%）是目前全球最常用的 MISST，其次是微型开放式方法（55.1%）和管状牵开器系统（41.8%）。最优选的脊柱内窥镜方法是经椎间孔技术 (56.2%)，其次是椎板间 (41.8%)、全内窥镜 (35.3%) 和顶部 MISST (13.7%)。结论 脊柱外科医生报告的 MISST 在日常临床实践中的实施率普遍高于其实践领域同行对 MISST 进入主流的认知接受率。调查表明，内窥镜脊柱手术现在是最常进行的 MISST。结论 脊柱外科医生报告的 MISST 在日常临床实践中的实施率普遍高于其实践领域同行对 MISST 进入主流的认知接受率。调查表明，内窥镜脊柱手术现在是最常进行的 MISST。结论 脊柱外科医生报告的 MISST 在日常临床实践中的实施率普遍高于其实践领域同行对 MISST 进入主流的认知接受率。调查表明，内窥镜脊柱手术现在是最常进行的 MISST。