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Page 236 Giakas et al. Art Int Surg 2024;4:233-46 https://dx.doi.org/10.20517/ais.2024.24

Table 1. Modified Global Quality Scale items
# Item
1 Poor quality, multiple unsubstantiated claims, most information missing. Not at all useful for patients
2 Generally poor quality, some unsubstantiated claims, some information listed but many important topics missing. Very limited use to patients
3 Moderate quality, some important information is adequately discussed, but others poorly discussed. Somewhat useful for patients
4 Good quality, minimal unsubstantiated claims, most of the relevant information is listed, but some topics not covered. Useful for patients
5 Excellent quality, comprehensive claims that are accurate and overall evidence-based. Very useful for patients

Attending 1 Score: 4
Attending 2 Score: 3

Analysis: ChatGPT provided a basic, but diverse general overview of why a patient might consider PLD. The
answer correctly identifies several general reasons for considering PLD, notably including “emergent cases”.
However, it does not mention any specific diagnoses that would be indications for surgery, such as
neurogenic claudication or radiculopathy [23-25] . Responses such as “health status” and “patient preference”
are quite vague. In particular, “patient preference” may be interpreted broadly as indicating that surgery is
simply optional, and many patients may use this as justification to avoid surgery. This answer should be
qualified with a warning that this is highly dependent on both the clinical scenario and underlying
pathology and that irreversible pain or neurologic deficit may result from delaying or avoiding surgery
without consulting with a spine surgeon. Finally, this answer overall lacks evidence-based responses that
might be useful to patients considering surgery.

2. What will happen if I delay lumbar decompression surgery?
Delaying lumbar decompression surgery might have various implications depending on your specific
condition and symptoms. While some conditions may tolerate a certain degree of delay, others might
worsen over time. It is important to consult with a healthcare professional, ideally a spine specialist, to
understand the potential consequences of delaying surgery in your individual case. Here are some general
considerations:

(1) Progression of symptoms: If you are experiencing pain, weakness, numbness, or other neurological
symptoms due to nerve compression, delaying surgery might lead to the progression of these symptoms.
Nerve compression can cause permanent damage if left untreated.
(2) Functional limitations: Nerve compression can affect your ability to perform daily activities, work, and
participate in recreational activities. Delaying surgery might limit your quality of life and functional abilities.
(3) Quality of life: The impact of your symptoms on your overall well-being and quality of life is an
important factor to consider. If your symptoms are significantly affecting your day-to-day life, addressing
them sooner through surgery might be beneficial.
(4) Impact on surgical outcome: In some cases, delaying surgery might lead to more complex surgery later,
as conditions can progress, and tissue changes might occur over time.
(5) Psychological impact: Chronic pain and limited mobility can have psychological effects, including
anxiety and depression. Addressing these issues through timely treatment might prevent their exacerbation.
(6) Risk of complications: If your symptoms are related to structural issues such as herniated discs, delaying
surgery could increase the risk of complications associated with nerve compression or other related
problems.