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.
All patients are advised to consult with their treating doctor always.
DR MICHAEL CORONEOS CIME MASE
NATIONAL RACS EXAMINER
TRIPLE PI ASSESSOR
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