The authors CenicA and Kachur,E from McMaster University in Hamilton, Ontario , Canada published this study in Can J Neurol Sci.2009 Mar;36(2):196-200.They wished to ascertain neurosurgical practices in the surgical management of single-level discectomies in the Canadian adult population.They surveyed 112 Canadian neurosurgeons and 88% performed lumbar adult discectomies.The relevant findings were;
(i)44%use BOTH Ct & MRI , 28% only used MRI and 15% used only CT pre-operatively,
(ii)57% used localization imaging PRIOR to skin incision
(iii) 92% used preoperative antibiotics
(iv)60% used pre-incision LA and 444% employed pre-closure LA
(v) 70% used a microscope, 19% loupes and 8% neither
(vi) only 12% use minimally invasive tubular retractors
(vii) 68% remove "as much disc as possible" and 31% remove " ONLY the herniated part"
(viii)in the case of dural tears 77% use fibrin glue
(ix) prior to skin closure 72% do NOT use a fat graft,61% used epidural steroids
(x) 58% are discharged on the next day,18% on the same day and 23% in two days
(xi) RTW is not recommended until at least 6 weeks post-op in 96%
(xii) most neurosurgeons ( 93%) would NOT operate on an individual with a chief complaint of low back pain.
My conclusions are that this study of eminent Canadian neurosurgeons is in keeping with the RANGE of practices that I have seen in Australia and internationally.We all have different ways of doing a single-level discectomy-BUT -one thing is for sure- MOST neurosurgeons do NOToperate if the chief complaint is lower back pain.This is the finding in this national Canadian study and the experience/practice of most Senior & experienced neurosurgeons with whom I have had experience with around the world, and locally.This is because the surgery WILL almost certainly fail , and in many cases the patients will be worse and remain on S8 narcotics, benzodiazepines etc.Patient selection in all surgery is CRUCIAL-and this is particularly the case in lumbar spine surgery in individuals who have a chief complaint of low back pain. Please read the link above.
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DR MICHAEL CORONEOS CIME MASE
NATIONAL RACS EXAMINER
TRIPLE PI ASSESSOR
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