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Vijay M. Ravindra, Guillermo Aldave, Howard L. Weiner, Timothy Lee, Michael A. Belfort, Magdelena Sanz-Cortes, Jimmy Espinoza, Alireza A. Shamshirsaz, Ahmed A. Nassr and William E. Whitehead

must be performed before 26 weeks’ gestational age. 1 The in utero diagnosis of MMC is usually made between 16 and 18 weeks. This gives expectant mothers 8–10 weeks to receive counseling, decide on treatment, and arrange fetal surgery if they so choose. The addition of fetal surgery as a treatment option, one of only a few neurosurgical procedures supported by a randomized trial, can significantly complicate prenatal counseling for MMC. At its core, the idea of shared decision-making means that patients have the opportunity to participate in decisions about their

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Yoji Ogura, Jeffrey L. Gum, Alex Soroceanu, Alan H. Daniels, Breton Line, Themistocles Protopsaltis, Richard A. Hostin, Peter G. Passias, Douglas C. Burton, Justin S. Smith, Christopher I. Shaffrey, Virginie Lafage, Renaud Lafage, Eric O. Klineberg, Han Jo Kim, Andrew Harris, Khaled Kebaish, Frank Schwab, Shay Bess, Christopher P. Ames, Leah Y. Carreon and the International Spine Study Group (ISSG)

, Passias, Burton, Smith, Shaffrey, V Lafage, R Lafage, Klineberg, Kim, Harris, Kebaish, Schwab, Bess, Ames, Carreon. Approved the final version of the manuscript on behalf of all authors: Ogura. Statistical analysis: Ogura, Soroceanu, Carreon. Administrative/technical/material support: Gum, Soroceanu, Daniels, Line, Protopsaltis, Hostin, Passias, Burton, Smith, Shaffrey, V Lafage, R Lafage, Klineberg, Kim, Harris, Kebaish, Bess, Ames, Carreon. Study supervision: Gum, Schwab, Ames, Carreon. References 1 Charles C , Gafni A , Whelan T . Shared decision-making in

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Matthew J. McGirt, Mohamad Bydon, Kristin R. Archer, Clinton J. Devin, Silky Chotai, Scott L. Parker, Hui Nian, Frank E. Harrell Jr., Theodore Speroff, Robert S. Dittus, Sharon E. Philips, Christopher I. Shaffrey, Kevin T. Foley and Anthony L. Asher

effectiveness of spine surgery vary significantly at the individual patient level. Recent evidence suggests that as many as 25% of diagnostic and therapeutic spine interventions are unnecessary or ineffective. 25 , 62 For this reason, providers, payers, and hospital systems all aim to identify which patient-specific or surgery-specific factors play significant roles in postoperative outcomes. In the current era of patient-centered care, engaging patients in shared decision-making in their treatment planning is imperative. Shared decision-making is defined as a process

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Alessandro Siccoli, Marlies P. de Wispelaere, Marc L. Schröder and Victor E. Staartjes

judgment in daily clinical routine. In this way, they may enable enhanced and more individualized shared decision-making. For example, a specific patient who has suffered from mild symptomatic LSS for 3 years may be unsure as to whether he or she should undergo surgery. Tailored predictive analytics may suggest that the patient, while having a very high chance at a minimum 30% symptomatic improvement, also is prone to reoperation at the index level, and to an extended length of hospital stay. In combination with counseling by an experienced surgeon, this would allow the

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Scott L. Parker, Matthew J. McGirt, Kimon Bekelis, Christopher M. Holland, Jason Davies, Clinton J. Devin, Tyler Atkins, Jack Knightly, Rachel Groman, Irene Zyung and Anthony L. Asher

M eaningful quality measurement and public reporting has the potential to facilitate targeted outcome improvement, practice-based learning, shared decision-making, and effective resource utilization. 140 Regrettably, regulatory and economic pressures have created a complex network of quality requirements for physicians and practice groups. These include the Centers for Medicare & Medicaid Services (CMS) Physician Quality Reporting System (PQRS), the CMS Electronic Health Records (EHR) Incentive Program (more commonly referred to as Meaningful Use [MU

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Lauren E. Franzblau, Mallory Maynard, Kevin C. Chung and Lynda J.-S. Yang

small but meaningful number of patients who are injured annually, yet little is known about how and why patients choose surgical intervention and what barriers exist in obtaining information and care. Moreover, most studies omit eligible individuals who decide against surgery, which underrepresents their perspectives in the literature. Many studies have demonstrated that shared decision making, a model defined by mutual exchange and collaboration, can improve patient outcomes, satisfaction with decisions, and compliance with care by fostering choices that align with

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Nicholas Dietz, Mayur Sharma, Ahmad Alhourani, Beatrice Ugiliweneza, Dengzhi Wang, Miriam A. Nuño, Doniel Drazin and Maxwell Boakye

those experiencing chronic pain, estimated at 54%–80%. 20 The lifetime incidence of neck pain has also been shown to be as high as 66%. 9 The incidence of cervical spine procedures increased from 2002 to 2009, with a total of 1,323,979 procedures being performed between those years according to Oglesby et al., 26 and Katz 16 reported an annual 298,000 lumbar fusion procedures. Given the prevalence of pathology requiring cervical and lumbar spinal procedures, predictive models that guide shared decision-making on projected outcomes are likely widely applicable in

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Kimon Bekelis, Matthew J. McGirt, Scott L. Parker, Christopher M. Holland, Jason Davies, Clinton J. Devin, Tyler Atkins, Jack Knightly, Rachel Groman, Irene Zyung and Anthony L. Asher

giving patients the tools to participate more meaningfully in shared decision making. Second, physicians and other health care professionals will be able to use these data to facilitate targeted quality improvement, practice-based learning, and effective resource utilization. Third, the data will allow policy makers and payers to more easily and accurately understand the true value of clinical interventions, an essential consideration in resource-intensive fields such as neurosurgery. In the end, better data will allow these various stakeholders to reward clinical

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Anthony L. Asher, Clinton J. Devin, Kristin R. Archer, Silky Chotai, Scott L. Parker, Mohamad Bydon, Hui Nian, Frank E. Harrell Jr., Theodore Speroff, Robert S. Dittus, Sharon E. Philips, Christopher I. Shaffrey, Kevin T. Foley and Matthew J. McGirt

understand the variability in RTW outcomes. In the current era of patient-centered care, engaging patients in shared decision-making in their treatment planning is of utmost importance. Shared decision-making is defined as a process “involving the patient and provider, both parties participating in the treatment decision-making process, requiring information sharing, and both parties agreeing to the treatment decision made.” 13 , 19 The concept of informed, shared decision-making was first popularized in a report issued by the President’s Commission for the Study of

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Nathan Evaniew, David W. Cadotte, Nicolas Dea, Christopher S. Bailey, Sean D. Christie, Charles G. Fisher, Jerome Paquet, Alex Soroceanu, Kenneth C. Thomas, Y. Raja Rampersaud, Neil A. Manson, Michael Johnson, Andrew Nataraj, Hamilton Hall, Greg McIntosh and W. Bradley Jacobs

myelopathy from the International Spine Study Group did not adjust for baseline mJOA scores or implement severity-based MCIDs. 26 , 32 , 33 Current clinical practice guidelines recommend surgery for patients with moderate or severe CSM, but acknowledge uncertainty in the management of patients with mild CSM. The 2017 guideline of AOSpine North America and the Cervical Spine Research Society states that patients with mild CSM may be offered either surgical intervention or a supervised trial of structured rehabilitation through a process of shared decision-making. 34 The