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Giakas et al. Art Int Surg 2024;4:233-46 https://dx.doi.org/10.20517/ais.2024.24 Page 237

Attending 1 Score: 3
Attending 2 Score: 3

Analysis: This ChatGPT response provides a somewhat useful overview of the potential results of delaying
surgery. However, it lacks any specific information as to the consequences of “nerve damage” that might be
useful to the patient considering surgery. Instead of providing specific information, such as increasing
muscle weakness, or loss of bowel or bladder function, the response focuses more on how delaying surgery
may impact a patient’s quality of life in general [26,27] . This response is reasonable, but lacks the specificity and
comprehensiveness needed by patients considering PLD. The complications associated with delaying
lumbar decompression surgery are vague and do not convey the potential severity involved with this
decision. Additionally, no data are provided to the patient in terms of the percentage of complications from
non-operative treatment, which may provide some context to the patient trying to understand the scope of
this choice.

3. What are the alternatives to lumbar decompression surgery?
There are several alternatives to lumbar decompression surgery that may be considered depending on your
specific condition, symptoms, and overall health. It is important to discuss these alternatives with a qualified
healthcare professional, preferably a spine specialist, to determine the most suitable treatment plan for your
individual situation. Here are some non-surgical alternatives to lumbar decompression surgery:

(1) Physical therapy: Physical therapy can help strengthen muscles, improve flexibility, and provide
strategies to manage pain. Therapists can design exercise programs tailored to your needs.
(2) Medications: Non-prescription pain relievers (e.g., acetaminophen, NSAIDs) or prescription
medications (e.g., muscle relaxants, neuropathic pain medications) can help manage pain and
inflammation.
(3) Epidural steroid injections: These injections can help reduce inflammation and provide temporary pain
relief. They are often used when pain is primarily due to nerve irritation.
(4) Lifestyle modifications: Making changes to your daily habits, such as maintaining a healthy weight,
improving posture, and avoiding activities that exacerbate your symptoms, can help manage pain and
prevent worsening of your condition.
(5) Chiropractic care: Chiropractors use manual manipulation techniques to improve spinal alignment and
alleviate pain. However, caution should be exercised if chiropractic care is considered for certain conditions.
(6) Bracing: Some conditions might benefit from wearing a supportive brace to help stabilize the spine and
reduce pain during certain activities.
(7) Watchful waiting: In some cases, especially for mild symptoms, your healthcare provider might
recommend monitoring your condition over time to see if it improves or worsens before considering more
invasive treatments.

Attending 1 Score: 3
Attending 2 Score: 4

Analysis: This response provides a good summation of alternative options to surgery that might be useful to
patients. However, it gives minimal detail regarding when these alternatives might be sufficient treatments,
and thus risks patients delaying or avoiding necessary surgery. In such instances when surgery is indicated,
initiating or continuing non-operative treatment might lead to progressive and permanent neurological
impairment for patients [28,29] . As such, while the response lists, in appropriate detail, options that might be
appropriate for some patients, pursuing these options might be highly detrimental for other patients.